Individual
KELLY R BURGESS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
202 BEVINS LANE, GEORGETOWN, KY 40324-9330
(859) 323-9333
Mailing address
202 BEVINS LANE, GEORGETOWN, KY 40324-9330
(859) 323-9333
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
35653
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000368877
BCBS
KY
01
—
G63969
UPIN
KY
Enumeration date
07/24/2006
Last updated
06/21/2016
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