Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | 3015926 | KY |
NPI | 1013594332 |
---|---|
Provider Name | Mrs. Kayla Jean Kelley |
First Address | Ashland, KY 41101-3744 |
Second Address | Coal Grove, OH 45638-2924 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/03/2021 |
Last Update Date | 02/02/2022 |