| Kelley Psychiatric Clinic | |
|
6025 Kentucky Dam Rd Paducah KY 42003-9472 | |
| (270) 898-4044 | |
| (270) 898-4045 |
| Full Name | Kelley Psychiatric Clinic |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 6025 Kentucky Dam Rd, Paducah, Kentucky |
| Authorized Official Name and Position | Ronald L. Kelley (CEO) |
| Authorized Official Contact | 2708984044 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Kelley Psychiatric Clinic Po Box 3126 Paducah KY 42002-3126 Ph: (270) 898-4044 | Kelley Psychiatric Clinic 6025 Kentucky Dam Rd Paducah KY 42003-9472 Ph: (270) 898-4044 |
| NPI Number | 1891772059 |
|---|---|
| Provider Enumeration Date | 12/29/2005 |
| Last Update Date | 01/02/2012 |
| Medicare PECOS PAC ID | 8820083611 |
|---|---|
| Medicare Enrollment ID | O20040420000460 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1891772059 | NPI | - | NPPES |
| 64151434 | Medicaid | KY |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103T00000X | Psychologist | (* (Not Available)) | Secondary |
| 2084P0804X | Psychiatry & Neurology - Child & Adolescent Psychiatry | (* (Not Available)) | Primary |
| Provider Name | Ronald L Kelley |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1033196019 PECOS PAC ID: 6800881509 Enrollment ID: I20120215001008 |
| Provider Name | Raymond Gordon Williams |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1235116203 PECOS PAC ID: 7012176050 Enrollment ID: I20120309000465 |
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