Provider Demographics
NPI:1831356849
Name:KOKER, KELLIE C (MA CCCA)
Entity type:Individual
Prefix:
First Name:KELLIE
Middle Name:C
Last Name:KOKER
Suffix:
Gender:F
Credentials:MA CCCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2601 KENTUCKY AVE
Mailing Address - Street 2:DOC BLDG 1, STE 201
Mailing Address - City:PADUCAH
Mailing Address - State:KY
Mailing Address - Zip Code:42003-3817
Mailing Address - Country:US
Mailing Address - Phone:270-575-0079
Mailing Address - Fax:270-575-0646
Practice Address - Street 1:2601 KENTUCKY AVE
Practice Address - Street 2:DOC BLDG 1, STE 201
Practice Address - City:PADUCAH
Practice Address - State:KY
Practice Address - Zip Code:42003-3817
Practice Address - Country:US
Practice Address - Phone:270-575-0079
Practice Address - Fax:270-575-0646
Is Sole Proprietor?:No
Enumeration Date:2008-05-19
Last Update Date:2008-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY0405237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter