Individual
MACKENZIE BRAE KELLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
613 23RD ST STE G10, ASHLAND, KY 41101-2886
(606) 408-5864
Mailing address
PO BOX 2379, ASHLAND, KY 41105-2379
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
3017986
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0498594
—
OH
05
—
7100835320
—
KY
Enumeration date
06/27/2022
Last updated
02/28/2023
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