Provider Demographics
NPI:1134727464
Name:LILLY, KAYELYNN LEE
Entity type:Individual
Prefix:
First Name:KAYELYNN
Middle Name:LEE
Last Name:LILLY
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 1:122 LANDIS LN
Mailing Address - Street 2:
Mailing Address - City:GREEN SPRING
Mailing Address - State:WV
Mailing Address - Zip Code:26722-4594
Mailing Address - Country:US
Mailing Address - Phone:304-359-5733
Mailing Address - Fax:
Practice Address - Street 1:122 LANDIS LN
Practice Address - Street 2:
Practice Address - City:GREEN SPRING
Practice Address - State:WV
Practice Address - Zip Code:26722-4594
Practice Address - Country:US
Practice Address - Phone:304-359-5733
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-09
Last Update Date:2021-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant