Individual
DR. KEITH EDWARD KELLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1920 BROADWAY ST, PADUCAH, KY 42001-7106
(270) 442-3647
(270) 442-3777
Mailing address
1920 BROADWAY ST, PADUCAH, KY 42001-7106
(270) 442-3647
(270) 442-3777
Taxonomy
Speciality
Code
Description
License number
State
207RP1001X
Pulmonary Disease Physician
Primary
39808
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
64113657
—
KY
01
—
P00266587
RAILROAD MEDICARE
KY
Enumeration date
08/31/2006
Last updated
12/07/2020
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