Provider Demographics
NPI:1942026463
Name:GEARLDS, KELLIE ANN
Entity type:Individual
Prefix:
First Name:KELLIE
Middle Name:ANN
Last Name:GEARLDS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1101 J CARTER RD
Mailing Address - Street 2:
Mailing Address - City:GLASGOW
Mailing Address - State:KY
Mailing Address - Zip Code:42141-8457
Mailing Address - Country:US
Mailing Address - Phone:270-427-6773
Mailing Address - Fax:
Practice Address - Street 1:1101 J CARTER RD
Practice Address - Street 2:
Practice Address - City:GLASGOW
Practice Address - State:KY
Practice Address - Zip Code:42141-8457
Practice Address - Country:US
Practice Address - Phone:270-427-6773
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-30
Last Update Date:2024-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1097603163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant