Provider Demographics
NPI:1629056015
Name:BURCHELL-YOUNG, KELLEY (MD)
Entity Type:Individual
Prefix:DR
First Name:KELLEY
Middle Name:
Last Name:BURCHELL-YOUNG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1342 BRIGHTLEAF BLVD
Mailing Address - Street 2:
Mailing Address - City:EDGEWOOD
Mailing Address - State:KY
Mailing Address - Zip Code:41018-3822
Mailing Address - Country:US
Mailing Address - Phone:859-371-7400
Mailing Address - Fax:859-371-8472
Practice Address - Street 1:45 CAVALIER BLVD
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:KY
Practice Address - Zip Code:41042-1684
Practice Address - Country:US
Practice Address - Phone:859-371-7400
Practice Address - Fax:859-371-8472
Is Sole Proprietor?:No
Enumeration Date:2006-01-05
Last Update Date:2016-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY38555208000000X, 2080A0000X
OH35083903B208000000X, 2080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64087471Medicaid