Healthcare Provider Details

I. General information

NPI: 1346275583
Provider Name (Legal Business Name): KELLY E KRIES MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2006
Last Update Date: 07/10/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

615 7TH AVE
BOWLING GREEN KY
42101
US

IV. Provider business mailing address

PO BOX 9880
BOWLING GREEN KY
42102-9880
US

V. Phone/Fax

Practice location:
  • Phone: 270-846-4800
  • Fax: 270-846-4828
Mailing address:
  • Phone: 270-846-4800
  • Fax: 270-846-4828

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number36146
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: