Provider Demographics
NPI:1831673698
Name:BALDRIDGE, KELLY CAROL
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:CAROL
Last Name:BALDRIDGE
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 1:271 W. SHORT ST SUITE 510
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40507
Mailing Address - Country:US
Mailing Address - Phone:859-310-6505
Mailing Address - Fax:606-886-4433
Practice Address - Street 1:271 W. SHORT ST SUITE 510
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40507
Practice Address - Country:US
Practice Address - Phone:859-310-6505
Practice Address - Fax:606-886-4433
Is Sole Proprietor?:No
Enumeration Date:2018-09-18
Last Update Date:2024-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health