Healthcare Provider Details

I. General information

NPI: 1376224337
Provider Name (Legal Business Name): KAILEY REDDEN B.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/31/2023
Last Update Date: 08/05/2025
Certification Date: 08/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

425 BROADWAY ST
PADUCAH KY
42001-0713
US

IV. Provider business mailing address

2116 PRIMITIVE DR APT B
MURRAY KY
42071-7899
US

V. Phone/Fax

Practice location:
  • Phone: 270-442-7121
  • Fax:
Mailing address:
  • Phone: 270-853-0602
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-23-280390
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: