Healthcare Provider Details

I. General information

NPI: 1467848952
Provider Name (Legal Business Name): KELLY RENEE DEATLEY M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KELLY RENEE MURPHY M.D.

II. Dates (important events)

Enumeration Date: 04/10/2015
Last Update Date: 10/10/2025
Certification Date: 10/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

325 W WALNUT ST STE 600
LEBANON KY
40033
US

IV. Provider business mailing address

325 W WALNUT ST STE 600
LEBANON KY
40033-1378
US

V. Phone/Fax

Practice location:
  • Phone: 270-699-9500
  • Fax: 270-699-9550
Mailing address:
  • Phone: 270-699-9500
  • Fax: 270-795-4015

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberR3750
License Number StateKY
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number51438
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: