Provider Demographics
NPI:1790561686
Name:SAYRE, KELLY
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:
Last Name:SAYRE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:460 WILSON AVE
Mailing Address - Street 2:
Mailing Address - City:VERSAILLES
Mailing Address - State:KY
Mailing Address - Zip Code:40383-1947
Mailing Address - Country:US
Mailing Address - Phone:859-753-6626
Mailing Address - Fax:859-787-0552
Practice Address - Street 1:460 WILSON AVE
Practice Address - Street 2:
Practice Address - City:VERSAILLES
Practice Address - State:KY
Practice Address - Zip Code:40383-1947
Practice Address - Country:US
Practice Address - Phone:859-753-6626
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-06
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY285874101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health