Provider Demographics
NPI:1780256420
Name:NALL, KEILE ELIZABETH
Entity type:Individual
Prefix:
First Name:KEILE
Middle Name:ELIZABETH
Last Name:NALL
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 1:292 S 2ND ST
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:KY
Mailing Address - Zip Code:40475-2102
Mailing Address - Country:US
Mailing Address - Phone:859-353-5505
Mailing Address - Fax:833-799-3656
Practice Address - Street 1:292 S 2ND ST
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:KY
Practice Address - Zip Code:40475-2102
Practice Address - Country:US
Practice Address - Phone:859-353-5505
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-13
Last Update Date:2023-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYRBT-21-170572106S00000X
KY289485103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician