Provider Demographics
NPI:1093948622
Name:FORD, KELLY (CST,CFA)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:
Last Name:FORD
Suffix:
Gender:F
Credentials:CST,CFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2200 E PARRISH AVE.
Mailing Address - Street 2:BLDG B, STE 203
Mailing Address - City:OWENSBORO
Mailing Address - State:KY
Mailing Address - Zip Code:42303
Mailing Address - Country:US
Mailing Address - Phone:270-691-9697
Mailing Address - Fax:270-691-0485
Practice Address - Street 1:2200 E PARRISH AVE.
Practice Address - Street 2:BLDG B, STE 203
Practice Address - City:OWENSBORO
Practice Address - State:KY
Practice Address - Zip Code:42303
Practice Address - Country:US
Practice Address - Phone:270-691-9697
Practice Address - Fax:270-691-0485
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-31
Last Update Date:2009-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY84189246Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246Z00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, Other