MEDICARE: KELLY DAWSON

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	259501	KY

General Provider Information

NPI Number	:	1770439820
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELLY DAWSON

Provider Business Mailing Address
First Line	:	1002 S VIRGINIA ST STE 401
Second Line	:
City	:	HOPKINSVILLE
State	:	KY
Zip	:	42240-3507
Country	:	US
Telephone Number	:	859-447-0855
Fax Number	:

Provider Business Practice Location Address
First Line	:	1002 S VIRGINIA ST STE 401
Second Line	:
City	:	HOPKINSVILLE
State	:	KY
Zip	:	42240-3507
Country	:	US
Telephone Number	:	859-447-0855
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/09/2026
Last Update Date	:	03/09/2026

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Directions to “ KELLY DAWSON ” Practice Location

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