Provider Demographics
NPI:1508845314
Name:BRUNSON, KELLY D (MD)
Entity Type:Individual
Prefix:DR
First Name:KELLY
Middle Name:D
Last Name:BRUNSON
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:1945 HIGHLAND PIKE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:FT WRIGHT
Mailing Address - State:KY
Mailing Address - Zip Code:41017-8127
Mailing Address - Country:US
Mailing Address - Phone:859-331-4005
Mailing Address - Fax:859-331-4606
Practice Address - Street 1:1945 HIGHLAND PIKE
Practice Address - Street 2:SUITE 1
Practice Address - City:FT WRIGHT
Practice Address - State:KY
Practice Address - Zip Code:41017-8127
Practice Address - Country:US
Practice Address - Phone:859-331-4005
Practice Address - Fax:859-331-4606
Is Sole Proprietor?:No
Enumeration Date:2006-01-10
Last Update Date:2020-01-20
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Provider Licenses
StateLicense IDTaxonomies
KY35102208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64069578Medicaid