Provider Demographics
NPI:1841795572
Name:BELCHER, KELLY CARLENE (APRN)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:CARLENE
Last Name:BELCHER
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 KARA DR
Mailing Address - Street 2:
Mailing Address - City:BEREA
Mailing Address - State:KY
Mailing Address - Zip Code:40403-2107
Mailing Address - Country:US
Mailing Address - Phone:859-661-5831
Mailing Address - Fax:
Practice Address - Street 1:9510 ORMSBY STATION RD
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40223-4081
Practice Address - Country:US
Practice Address - Phone:502-327-9100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-26
Last Update Date:2018-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3011725363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
14254406OtherCAQH