Provider Demographics
NPI:1215341821
Name:DEVERS, KELLY I (AAS)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:
Last Name:DEVERS
Suffix:I
Gender:F
Credentials:AAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:615 WESTPORT RD
Mailing Address - Street 2:
Mailing Address - City:ELIZABETHTOWN
Mailing Address - State:KY
Mailing Address - Zip Code:42701-2874
Mailing Address - Country:US
Mailing Address - Phone:270-737-6449
Mailing Address - Fax:270-737-8408
Practice Address - Street 1:615 WESTPORT RD
Practice Address - Street 2:
Practice Address - City:ELIZABETHTOWN
Practice Address - State:KY
Practice Address - Zip Code:42701-2874
Practice Address - Country:US
Practice Address - Phone:270-737-6449
Practice Address - Fax:270-737-8408
Is Sole Proprietor?:No
Enumeration Date:2014-06-12
Last Update Date:2014-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)