Individual
KARL DAVID KELLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
310 N L ROGERS WELLS BLVD, GLASGOW, KY 42141-1300
(270) 659-5555
Mailing address
4059 KEITH RD, SPRINGFIELD, TN 37172-6971
(615) 384-6222
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
38748
TN
207P00000X
Emergency Medicine Physician
Primary
46833
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
10021964
OMNICARE TENNCARE
TN
05
—
3809694
—
TN
01
—
3897033
BLUE CROSS
TN
05
—
3897036
—
TN
01
—
4086997
BLUE CROSS
TN
01
—
41090
TLC TENNCARE
TN
01
—
4124223
BLUE CROSS
TN
01
—
4124510
BLUE CROSS
TN
01
—
50007338
PASSPORT HEALTH
KY
05
—
64086663
—
KY
01
—
P00241188
MEDICARE RAILROAD
TN
01
—
P00357334
MEDICARE RAILROAD
TN
Enumeration date
06/07/2006
Last updated
01/18/2024
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