MEDICARE: KELLI CARPENTER GC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	170300000X	Genetic Counselor (M.S.)	GC511	KY

General Provider Information

NPI Number	:	1043091747
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELLI CARPENTER GC

Provider Business Mailing Address
First Line	:	409 HAYS BLVD
Second Line	:
City	:	LEXINGTON
State	:	KY
Zip	:	40509-4496
Country	:	US
Telephone Number	:	606-748-3352
Fax Number	:

Provider Business Practice Location Address
First Line	:	740 S LIMESTONE STE K201
Second Line	:
City	:	LEXINGTON
State	:	KY
Zip	:	40536-3215
Country	:	US
Telephone Number	:	859-218-2509
Fax Number	:	859-323-3499

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/09/2023
Last Update Date	:	07/22/2024

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Directions to “ KELLI CARPENTER GC” Practice Location

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