Individual
SANDRA TRACEY KELLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
845 ANGLIANA AVE, LEXINGTON, KY 40508-3146
(859) 323-9321
Mailing address
801 FOREST LAKE DR, LEXINGTON, KY 40515-6299
(859) 273-3774
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
1264
KY
207RA0401X
Addiction Medicine (Internal Medicine) Physician
3003542
KY
363LF0000X
Family Nurse Practitioner
Primary
3003542
KY
Other
Enumeration date
02/03/2007
Last updated
06/28/2019
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