Healthcare Provider Details

I. General information

NPI: 1700713138
Provider Name (Legal Business Name): KAELYN GRACE DUNN RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/07/2026
Last Update Date: 05/07/2026
Certification Date: 05/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

621 VALENTINE BRANCH RD
CANNON KY
40923-6371
US

IV. Provider business mailing address

621 VALENTINE BRANCH RD
CANNON KY
40923-6371
US

V. Phone/Fax

Practice location:
  • Phone: 606-595-0827
  • Fax:
Mailing address:
  • Phone: 606-595-0827
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number4020399
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: