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General NPI Number Information
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NPI Number | 1740946904
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Entity Type | Individual
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Provider Name | BETHANY A KELLEY MED, LPA
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Gender | Female
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Dates
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Enumeration Date | 11/11/2021
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Last Update Date | 04/18/2024
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Provider Practice Location Address
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Address Line | 6500 GLENRIDGE PARK PL STE 3
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City | LOUISVILLE
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State | KY
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Zip | 40222-3450
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Country | US
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Telephone | 502-614-7600
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Fax |
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Provider Business Mailing Address
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Address Line | 591 BEECH GROVE RD
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City | SHEPHERDSVILLE
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State | KY
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Zip | 40165-6483
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Country | US
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Telephone | 502-468-2123
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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 | 103TC1900X
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Taxonomy Name | Counseling Psychologist
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License Number | 288702
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License Number State | KY
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