Healthcare Provider Details

I. General information

NPI: 1073766028
Provider Name (Legal Business Name): KELLI J FARMER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/03/2008
Last Update Date: 01/06/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

260 HOSPITAL DR
SOUTH WILLIAMSON KY
41503-4072
US

IV. Provider business mailing address

260 HOSPITAL DR
SOUTH WILLIAMSON KY
41503-4072
US

V. Phone/Fax

Practice location:
  • Phone: 606-237-1700
  • Fax:
Mailing address:
  • Phone: 606-237-1460
  • Fax: 606-237-1461

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number3618
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: