Provider Demographics
NPI:1245278043
Name:KELLY, DAVID ROBERT (MD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:ROBERT
Last Name:KELLY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:309 LEAWOOD DR
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40502-3218
Mailing Address - Country:US
Mailing Address - Phone:859-278-8499
Mailing Address - Fax:859-278-8683
Practice Address - Street 1:1780 NICHOLASVILLE RD
Practice Address - Street 2:SUITE 201
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40503-1400
Practice Address - Country:US
Practice Address - Phone:859-278-8499
Practice Address - Fax:859-278-8683
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-03
Last Update Date:2010-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY275702084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64275704Medicaid
KYF78438Medicare UPIN
KY64275704Medicaid