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NPI Code Detail

MEDICARE: KALLYE JOANAH RENNER PHD

MEDICARE: KALLYE JOANAH RENNER PHD
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
1103TC0700XClinical Psychologist265759KY

General Provider Information

NPI Number : 1093299299
Entity Type Code : Individual
Provider Name (Legal Business Name) : KALLYE JOANAH RENNER PHD
Provider Business Mailing Address
First Line : 7426 US 42 STE 106
Second Line :
City : FLORENCE
State : KY
Zip : 41042-2056
Country : US
Telephone Number : 859-282-0119
Fax Number :
Provider Business Practice Location Address
First Line : 7426 US 42 STE 106
Second Line :
City : FLORENCE
State : KY
Zip : 41042-2056
Country : US
Telephone Number : 859-282-0119
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/24/2018
Last Update Date : 11/11/2021

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Directions to “ KALLYE JOANAH RENNER PHD” Practice Location

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