Provider Demographics
NPI:1790280543
Name:ALBRECHT, KELLI RENEE (DO)
Entity type:Individual
Prefix:
First Name:KELLI
Middle Name:RENEE
Last Name:ALBRECHT
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:KELLI
Other - Middle Name:RENEE
Other - Last Name:PRATT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 776351
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60677-6351
Mailing Address - Country:US
Mailing Address - Phone:502-559-9407
Mailing Address - Fax:502-272-5339
Practice Address - Street 1:2108 NICHOLASVILLE RD FL 2
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40503-2502
Practice Address - Country:US
Practice Address - Phone:859-278-9413
Practice Address - Fax:859-276-0715
Is Sole Proprietor?:No
Enumeration Date:2018-03-26
Last Update Date:2025-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY05661207Q00000X
OH34.015024207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100616550Medicaid