Provider Demographics
NPI:1598747396
Name:KELLY, PATRICK SEAN (MD)
Entity Type:Individual
Prefix:
First Name:PATRICK
Middle Name:SEAN
Last Name:KELLY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:P
Other - Middle Name:SEAN
Other - Last Name:KELLY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1000 S 12TH ST
Mailing Address - Street 2:
Mailing Address - City:MURRAY
Mailing Address - State:KY
Mailing Address - Zip Code:42071-9303
Mailing Address - Country:US
Mailing Address - Phone:270-759-9200
Mailing Address - Fax:270-759-9966
Practice Address - Street 1:803 POPLAR ST
Practice Address - Street 2:
Practice Address - City:MURRAY
Practice Address - State:KY
Practice Address - Zip Code:42071-2432
Practice Address - Country:US
Practice Address - Phone:270-762-1100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-17
Last Update Date:2023-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY32195207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000050312OtherANTHEM PROVIDER NUMBER
KY64321953Medicaid
KY110168896OtherRAILROAD MEDICARE PROV NO
KY64321953Medicaid
KY000000050312OtherANTHEM PROVIDER NUMBER