Provider Demographics
NPI:1467838300
Name:RENFROE, KELLINA ELIZABETH (BSN, RN)
Entity Type:Individual
Prefix:MRS
First Name:KELLINA
Middle Name:ELIZABETH
Last Name:RENFROE
Suffix:
Gender:F
Credentials:BSN, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1454 CRESTVIEW DR
Mailing Address - Street 2:
Mailing Address - City:RADCLIFF
Mailing Address - State:KY
Mailing Address - Zip Code:40160-9592
Mailing Address - Country:US
Mailing Address - Phone:270-769-3377
Mailing Address - Fax:
Practice Address - Street 1:320 RING RD
Practice Address - Street 2:
Practice Address - City:ELIZABETHTOWN
Practice Address - State:KY
Practice Address - Zip Code:42701-6777
Practice Address - Country:US
Practice Address - Phone:270-769-3377
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-03
Last Update Date:2015-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1103930163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse