Provider Demographics
NPI:1891772059
Name:RONALD L. KELLEY PSC
Entity Type:Organization
Organization Name:RONALD L. KELLEY PSC
Other - Org Name:KELLEY PSYCHIATRIC CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:L
Authorized Official - Last Name:KELLEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:270-898-4044
Mailing Address - Street 1:PO BOX 3126
Mailing Address - Street 2:
Mailing Address - City:PADUCAH
Mailing Address - State:KY
Mailing Address - Zip Code:42002-3126
Mailing Address - Country:US
Mailing Address - Phone:270-898-4044
Mailing Address - Fax:270-898-4045
Practice Address - Street 1:6025 KENTUCKY DAM RD
Practice Address - Street 2:
Practice Address - City:PADUCAH
Practice Address - State:KY
Practice Address - Zip Code:42003-9472
Practice Address - Country:US
Practice Address - Phone:270-898-4044
Practice Address - Fax:270-898-4045
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-29
Last Update Date:2012-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent PsychiatryGroup - Multi-Specialty
No103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64151434Medicaid
KY64151434Medicaid
KYC71252Medicare UPIN