Healthcare Provider Details

I. General information

NPI: 1043091747
Provider Name (Legal Business Name): KELLI CARPENTER GC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/09/2023
Last Update Date: 07/22/2024
Certification Date: 07/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

740 S LIMESTONE STE K201
LEXINGTON KY
40536-3215
US

IV. Provider business mailing address

409 HAYS BLVD
LEXINGTON KY
40509-4496
US

V. Phone/Fax

Practice location:
  • Phone: 859-218-2509
  • Fax: 859-323-3499
Mailing address:
  • Phone: 606-748-3352
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code170300000X
TaxonomyGenetic Counselor (M.S.)
License NumberGC511
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: