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NPI Code Detail

MEDICARE: DR. KELLY LYNN WHITAKER PHARMD, CDE

MEDICARE: DR. KELLY LYNN WHITAKER PHARMD, CDE
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
1183500000XPharmacist011861KY
2163WD0400XDiabetes Educator Registered Nurse20410432KY

General Provider Information

NPI Number : 1558514489
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. KELLY LYNN WHITAKER PHARMD, CDE
Provider Business Mailing Address
First Line : 2670 NEW HOLT RD STE D
Second Line :
City : PADUCAH
State : KY
Zip : 42001-7506
Country : US
Telephone Number : 270-444-7070
Fax Number :
Provider Business Practice Location Address
First Line : 2670 NEW HOLT RD STE D
Second Line :
City : PADUCAH
State : KY
Zip : 42001-7506
Country : US
Telephone Number : 270-444-7070
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/22/2008
Last Update Date : 12/04/2019

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