Most Relevant Information
Provider Data
| NPI Number: | 1003310921 |
| Provider Name: | STEPHANIE RAE KELTY APRN |
| Entity Type: | Individual |
| Taxonomy Code: | 363LP0200X |
| Specialty: | Nurse Practitioner |
| License Number: | 3012197 |
Most Important Dates
| Enumeration Date: | 03/23/2018 |
| Last Updated: | 08/22/2024 |
Provider Practice Location
1301 RING RD
ELIZABETHTOWN
KY
427018968
Practice Location Phone/Fax
| Phone: | 2707652107 |
| Fax: | 2707699642 |
Provider Mailing Location
PO BOX 776351
CHICAGO
IL
606776351
Provider Mailing Phone/Fax
| Phone: | 5025889490 |
| Fax: | 5022725116 |