Provider Demographics
NPI:1861590499
Name:MORGAN, KELLI W (MD)
Entity type:Individual
Prefix:DR
First Name:KELLI
Middle Name:W
Last Name:MORGAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:114 MANOR AVE
Mailing Address - Street 2:
Mailing Address - City:BARDSTOWN
Mailing Address - State:KY
Mailing Address - Zip Code:40004-3230
Mailing Address - Country:US
Mailing Address - Phone:502-349-9999
Mailing Address - Fax:502-349-9499
Practice Address - Street 1:114 MANOR AVE
Practice Address - Street 2:
Practice Address - City:BARDSTOWN
Practice Address - State:KY
Practice Address - Zip Code:40004-3230
Practice Address - Country:US
Practice Address - Phone:502-349-9999
Practice Address - Fax:502-349-9499
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2022-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY33049207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64018724Medicaid
KY64018724Medicaid
H19629Medicare UPIN