Provider Demographics
NPI:1770049751
Name:CANTERBERRY, KELLY FRANCES (NP-C)
Entity type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:FRANCES
Last Name:CANTERBERRY
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:KELLY
Other - Middle Name:FRANCES
Other - Last Name:FLACH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:526 BILL DORRIS RD
Mailing Address - Street 2:
Mailing Address - City:CLAY
Mailing Address - State:KY
Mailing Address - Zip Code:42404-9507
Mailing Address - Country:US
Mailing Address - Phone:941-224-5526
Mailing Address - Fax:
Practice Address - Street 1:343 E CENTER ST
Practice Address - Street 2:
Practice Address - City:MADISONVILLE
Practice Address - State:KY
Practice Address - Zip Code:42431-2135
Practice Address - Country:US
Practice Address - Phone:270-452-2420
Practice Address - Fax:270-452-2438
Is Sole Proprietor?:No
Enumeration Date:2019-02-14
Last Update Date:2022-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3013140363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily