Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223G0001X | General Practice | 9453 | KY |
Y | 213EG0000X | General Practice | 9453 | KY |
NPI | 1003228602 |
---|---|
Provider Name | Dr. Carson Keally |
First Address | Winchester, KY 40391-2412 |
Second Address | Winchester, KY 40391-2412 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/05/2014 |
Last Update Date | 30/05/2014 |