Provider Demographics
NPI:1043091747
Name:CARPENTER, KELLI (MS, LCGC)
Entity Type:Individual
Prefix:
First Name:KELLI
Middle Name:
Last Name:CARPENTER
Suffix:
Gender:F
Credentials:MS, LCGC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:409 HAYS BLVD
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40509-4496
Mailing Address - Country:US
Mailing Address - Phone:606-748-3352
Mailing Address - Fax:
Practice Address - Street 1:138 LEADER AVE STE 116
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40508-3215
Practice Address - Country:US
Practice Address - Phone:859-218-6902
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-09
Last Update Date:2023-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY170300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170300000XOther Service ProvidersGenetic Counselor, MS