Healthcare Provider Details

I. General information

NPI: 1235352147
Provider Name (Legal Business Name): SCOTT P KELLIE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/10/2007
Last Update Date: 03/05/2024
Certification Date: 03/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4003 KRESGE WAY STE 312
LOUISVILLE KY
40207-4652
US

IV. Provider business mailing address

4003 KRESGE WAY SUITE 312
LOUISVILLE KY
40207-4652
US

V. Phone/Fax

Practice location:
  • Phone: 502-899-7377
  • Fax: 502-899-1972
Mailing address:
  • Phone: 502-899-7377
  • Fax: 502-899-1972

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License NumberR1251
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number42869
License Number StateKY
# 3
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number42869
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: