Provider Demographics
NPI:1063433324
Name:SINGLETARY, KELLYE NICHOL (MD)
Entity type:Individual
Prefix:
First Name:KELLYE
Middle Name:NICHOL
Last Name:SINGLETARY
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:239 LANSDOWNE CRES
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40245-7202
Mailing Address - Country:US
Mailing Address - Phone:502-386-5130
Mailing Address - Fax:
Practice Address - Street 1:927 W MAIN ST
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202-2621
Practice Address - Country:US
Practice Address - Phone:502-632-3500
Practice Address - Fax:888-965-1418
Is Sole Proprietor?:No
Enumeration Date:2006-07-22
Last Update Date:2025-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC1440912084P0800X
TXP34512084P0800X
KY402732084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100244180Medicaid