1609071331 NPI number — MRS. KELLY S NUNLEY MA, LPCC

Table of content: MRS. KELLY S NUNLEY MA, LPCC (NPI 1609071331)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609071331 NPI number — MRS. KELLY S NUNLEY MA, LPCC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
NUNLEY
Provider First Name:
KELLY
Provider Middle Name:
S
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MA, LPCC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1609071331
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/16/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
501 DARBY CREEK SUITE # 11
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LEXINGTON
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
40509
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
859-338-0466
Provider Business Mailing Address Fax Number:
859-294-0802

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5011 ATWOOD DRIVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RICHMOND
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40475
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
859-314-1281
Provider Business Practice Location Address Fax Number:
859-353-8032
Provider Enumeration Date:
06/21/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YP2500X , with the licence number:  0529 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 7100284980 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com