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General NPI Number Information
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NPI Number | 1083157028
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Entity Type | Individual
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Provider Name | KELLEY WILLIG
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Gender | Female
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Dates
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Enumeration Date | 11/23/2016
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Last Update Date | 01/31/2025
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Provider Practice Location Address
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Address Line | 650 JOEL DR
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City | FORT CAMPBELL
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State | KY
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Zip | 42223-5318
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Country | US
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Telephone | 270-956-1777
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Fax |
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Provider Business Mailing Address
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Address Line | 3091 SINGLETREE DR
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City | HOPKINSVILLE
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State | KY
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Zip | 42240-9115
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Country | US
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Telephone | 270-985-1666
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 254061
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License Number State | KY
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