Individual
AMANDA KAY KELLY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
298 MEDLEY CT, VINE GROVE, KY 40175-8421
(270) 352-1133
Mailing address
128 CRESTVIEW DR, BRANDENBURG, KY 40108-1216
(270) 945-5099
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
23-256142
KY
Other
Enumeration date
02/13/2023
Last updated
02/13/2023
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