Provider Demographics
NPI:1952101875
Name:SWEENEY, KELSEY RENEE
Entity type:Individual
Prefix:
First Name:KELSEY
Middle Name:RENEE
Last Name:SWEENEY
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 AXIS DR APT 312
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40206-0080
Mailing Address - Country:US
Mailing Address - Phone:757-817-8448
Mailing Address - Fax:
Practice Address - Street 1:300 AXIS DR APT 312
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40206-0080
Practice Address - Country:US
Practice Address - Phone:757-817-8448
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-18
Last Update Date:2025-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program