Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Kentucky Blue Medical LLC

Organization Neuromusculoskeletal Medicine & OMM Physician · NPI 1063862506

Kentucky Blue Medical LLC is a Neuromusculoskeletal Medicine & OMM Physician in Louisville, Kentucky. Registered with an NPI since 2016.

In the registry since
2016
What do these letters mean?
LLC — Limited liability company
A form of business registration, not a clinical qualification.

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Practice location Address checks out

4602 Southern Pkwy Ste 1A
Louisville, KY 40214-1442
Phone: (502) 361-1159
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Neuromusculoskeletal Medicine & OMM Physician (primary) Taxonomy 204D00000X

Record details

NPI number1063862506
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Cranston Sheppard — Owner · (502) 361-1159
NPI enumeratedJune 15, 2016
Last updated in NPPESJune 15, 2016
Mailing address4602 Southern Pkwy Ste 1a, Louisville, KY 40214-1442

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