Healthcare Provider Details

I. General information

NPI: 1457865370
Provider Name (Legal Business Name): KELSEY COLLEY PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/30/2017
Last Update Date: 07/27/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1019 PADUCAH RD STE C
MAYFIELD KY
42066-3616
US

IV. Provider business mailing address

5050 VILLAGE SQUARE DR STE B
PADUCAH KY
42001-7552
US

V. Phone/Fax

Practice location:
  • Phone: 502-565-9737
  • Fax: 270-477-0007
Mailing address:
  • Phone: 270-310-9200
  • Fax: 270-477-0007

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number3443
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA3011
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: