Healthcare Provider Details

I. General information

NPI: 1588638969
Provider Name (Legal Business Name): KELLY L COLE D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/14/2006
Last Update Date: 11/20/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

121 E MAIN ST
PROVIDENCE KY
42450-1268
US

IV. Provider business mailing address

PO BOX 310
PROVIDENCE KY
42450-0310
US

V. Phone/Fax

Practice location:
  • Phone: 270-667-2023
  • Fax: 270-667-7518
Mailing address:
  • Phone: 270-667-2023
  • Fax: 270-667-7518

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number02437
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: