Individual
KELLY RENEE DEATLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
325 W WALNUT ST STE 600, LEBANON, KY 40033
(270) 699-9500
(270) 699-9550
Mailing address
325 W WALNUT ST STE 600, LEBANON, KY 40033-1378
(270) 699-9500
(270) 795-4015
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
51438
KY
207Q00000X
Family Medicine Physician
R3750
KY
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7100432940
—
KY
Enumeration date
04/10/2015
Last updated
10/10/2025
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