Healthcare Provider Details

I. General information

NPI: 1972368454
Provider Name (Legal Business Name): NELLA CHRISTY PRYOR MA, CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/14/2024
Last Update Date: 02/14/2024
Certification Date: 02/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2150 LEXINGTON RD STE A
RICHMOND KY
40475-7924
US

IV. Provider business mailing address

205 GENERAL CLEBURN DR
RICHMOND KY
40475-8891
US

V. Phone/Fax

Practice location:
  • Phone: 859-353-5445
  • Fax:
Mailing address:
  • Phone: 859-248-0865
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number142532
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: