Healthcare Provider Details

I. General information

NPI: 1629056015
Provider Name (Legal Business Name): KELLEY BURCHELL-YOUNG M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/05/2006
Last Update Date: 03/10/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45 CAVALIER BLVD
FLORENCE KY
41042-1684
US

IV. Provider business mailing address

1342 BRIGHTLEAF BLVD
EDGEWOOD KY
41018-3822
US

V. Phone/Fax

Practice location:
  • Phone: 859-371-7400
  • Fax: 859-371-8472
Mailing address:
  • Phone: 859-371-7400
  • Fax: 859-371-8472

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number38555
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number35083903B
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License Number38555
License Number StateKY
# 4
Primary TaxonomyN
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License Number35083903B
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: