Provider Demographics
NPI:1033196019
Name:KELLEY, RONALD L (MD)
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:L
Last Name:KELLEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6025 KENTUCKY DAM RD
Mailing Address - Street 2:
Mailing Address - City:PADUCAH
Mailing Address - State:KY
Mailing Address - Zip Code:42003-9472
Mailing Address - Country:US
Mailing Address - Phone:270-898-4044
Mailing Address - Fax:270-898-4045
Practice Address - Street 1:6025 KENTUCKY DAM RD
Practice Address - Street 2:
Practice Address - City:PADUCAH
Practice Address - State:KY
Practice Address - Zip Code:42003-9472
Practice Address - Country:US
Practice Address - Phone:270-898-4044
Practice Address - Fax:270-898-4045
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-29
Last Update Date:2010-11-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KY151432084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry