Provider Demographics
NPI:1558514489
Name:WHITAKER, KELLY LYNN (PHARMD, CDE)
Entity Type:Individual
Prefix:DR
First Name:KELLY
Middle Name:LYNN
Last Name:WHITAKER
Suffix:
Gender:F
Credentials:PHARMD, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2670 NEW HOLT RD STE D
Mailing Address - Street 2:
Mailing Address - City:PADUCAH
Mailing Address - State:KY
Mailing Address - Zip Code:42001-7506
Mailing Address - Country:US
Mailing Address - Phone:270-444-7070
Mailing Address - Fax:
Practice Address - Street 1:2670 NEW HOLT RD STE D
Practice Address - Street 2:
Practice Address - City:PADUCAH
Practice Address - State:KY
Practice Address - Zip Code:42001-7506
Practice Address - Country:US
Practice Address - Phone:270-444-7070
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-10-22
Last Update Date:2019-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY011861183500000X
KY20410432163WD0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WD0400XNursing Service ProvidersRegistered NurseDiabetes Educator
No183500000XPharmacy Service ProvidersPharmacist