DR. CHARLES JUDE KELLY (NPI# 1972576098) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1972576098 |
| Entity Type | Individual |
| Full Name | DR. CHARLES JUDE KELLY |
| Credential | MD |
| Practice Address |
20 Medical Village Dr Suite 102 Edgewood KY 41017-5401 |
| Practice Telephone | 8593411011 |
| Practice Fax Number | 8593417198 |
| Mailing Telephone | 8593411011 |
| Mailing Fax Number | 8593417198 |
| Enumeration Date | 2006-02-09 |
| Last Update Date | 2007-07-08 |
| Gender Code | M |
| Is Sole Proprietor | X |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 208000000X | Pediatrics | 35 07 8628 | OH | Allopathic & Osteopathic Physicians |
| Y | 208000000X | Pediatrics | 34229 | KY | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| KY | 64013543 | 05 | |
| AETNA | 2501317 | 01 | |
| ANTHEM | 000000175988 | 01 | |
| CIGNA | 7499170002 | 01 | |
| UNITED HEALTH CARE OF OHI | 1202784 | 01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1366765661 | Charles Christopher Kelly | Massage Therapist | 124 Arborgate Cir, Columbia, SC 29212-2465 | 2010-03-01 |
| 1730123639 | Charles E Kelly | Specialist | 3050 Centre Pointe Drive, Suite 200, Roseville, MN 55113 | 2006-06-15 |
| 1780678979 | Charles E Kelly II | Specialist | 2839 Hwy 231 North, Suite 208a, Shelbyville, TN 37160-7449 | 2005-09-02 |
| 1922588292 | Charles Kelly | Physical Therapy Assistant | 401 Oakwood Blvd, Round Rock, TX 78681 | 2018-08-16 |
| 1093247447 | Charles Michael Kelly II | Family Medicine | 210 9th St Se, Rochester, MN 55904-6756 | 2017-04-03 |
| 1508013103 | Charles J Kelly | Counselor | 21 Franciscan Way, Garrison, NY 10524-0150 | 2008-08-26 |
| 1518025683 | Charles L Kelly | Social Worker | 40 Industrial Park Rd, Department of Mental Health, Plymouth, MA 02360-4884 | 2006-12-04 |
| 1447367461 | Charles Francis Kelly | Chiropractor | 36410 Garfield, Clinton Township, MI 48035-1131 | 2006-08-24 |
| 1760402473 | Charles A. Kelly | Psychiatry & Neurology | 913 Bowman Rd # B, Mt Pleasant, SC 29464-3235 | 2006-07-19 |
| 1528009800 | Charles Michael Kelly | Orthopaedic Surgery | 7710 Mercy Rd, Suite 224, Omaha, NE 68124-2372 | 2006-06-09 |
| Street Address |
20 MEDICAL VILLAGE DR SUITE 102 |
| City | EDGEWOOD |
| State | KY |
| Zip Code | 41017-5401 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1841295243 | Paul Allen Jacobs | Obstetrics & Gynecology | 20 Medical Village Dr, Ste 302, Edgewood, KY 41017-5402 | 2005-06-14 |
| 1043821085 | David Thomas Tackett | Nurse Practitioner | 20 Medical Village Dr, Edgewood, KY 41017-5401 | 2020-08-13 |
| 1245866888 | Annalee Fitzpatrick | Nurse Practitioner | 20 Medical Village Dr, Edgewood, KY 41017-5401 | 2020-03-16 |
| 1972137313 | Thomas Gravely | Pharmacist | 20 Medical Village Dr, Edgewood, KY 41017-5401 | 2020-02-25 |
| 1205487071 | Amanda M Hofmeyer | Nurse Practitioner | 20 Medical Village Dr, Edgewood, KY 41017-5401 | 2019-09-24 |
| 1528535804 | Heidi Ann Ducker | Nurse Practitioner | 20 Medical Village Dr, Edgewood, KY 41017-5401 | 2018-10-25 |
| 1316433014 | Tara Nagaraj | Pharmacist | 20 Medical Village Dr, Edgewood, KY 41017 | 2018-07-05 |
| 1033628268 | Jennifer Teresa Sprague | Physician Assistant | 20 Medical Village Dr, Edgewood, KY 41017-5401 | 2017-09-20 |
| 1235658857 | Eric Joseph Faris | Nurse Practitioner | 20 Medical Village Dr, Edgewood, KY 41017 | 2017-09-14 |
| 1356876940 | Jennifer Vaden | Registered Nurse | 20 Medical Village Dr, Suite 301, Edgewood, KY 41017-5401 | 2017-04-20 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1578187209 | St. Elizabeth Medical Center, Inc. | Pharmacy | 1 Medical Village Dr., Edgewood, KY 41017 | 2020-05-28 |
| 1366084337 | St. Elizabeth Medical Center, Inc. | Pharmacy | 850 Thomas More Parkway, Edgewood, KY 41017 | 2019-10-11 |
| 1396396750 | Family First Vision Care Kentucky | Optometrist | 614 Buttermilk Pike, Fort Mitchell, KY 41017 | 2019-09-26 |
| 1083184543 | Katie Franconia Smith | Nurse Practitioner | 2865 Chancellor Dr., Crestview Hills, KY 41017 | 2018-11-27 |
| 1871077511 | Janet Reeves Martin | Nurse Practitioner | Infinity Dialysis, 4750 East Galbraith Rd. Suite 103, Cincinnati, OH 41017 | 2018-09-19 |
| 1144713983 | Kelly Wiechart | Dentist | 599 Freedom Park Dr Ste 100, Crestview Hills, KY 41017 | 2018-06-06 |
| 1225535966 | Proscan Radiology Northern Kentucky, LLC | Radiology | 350 Thomas More Pkwy Ste 170, Crestview Hills, KY 41017 | 2018-04-10 |
| 1396241626 | Tressa S. Leahy | Physical Therapist | 200 Medical Village Drive, Edgewood, KY 41017 | 2018-04-04 |
| 1699294470 | Raymond Gardinier | Physical Therapist | 3755 Old Ky 17, Fort Wright, KY 41017 | 2017-09-13 |
| 1992229785 | Adrienne Bussard | Physician Assistant | 334 Thomas More Pkwy Ste 120, Crestview Hills, KY 41017 | 2017-08-02 |
| Find all providers in zip 41017 | ||||
| Taxonomy Code | 208000000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Pediatrics |
| A pediatrician is concerned with the physical, emotional and social health of children from birth to young adulthood. Care encompasses a broad spectrum of health services ranging from preventive healthcare to the diagnosis and treatment of acute and chronic diseases. A pediatrician deals with biological, social and environmental influences on the developing child, and with the impact of disease and dysfunction on development. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Pediatrics, 2007. http://www.abp.org/. American Osteopathic Board of Pediatrics, 2007. http://www.osteopathic.org/certificatio - Board certification for Medical Doctors (MDs) is provided by the American Board of Pediatrics. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Pediatrics. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1699905927 | Edgewood Pediatric Clinic L.L.C. | Pediatrics | 2 Eunice Ct Bldg B, Edgewood, NM 87015-9108 | 2009-07-21 |
| 1679717789 | Alan Mannheimer | Pediatrics | 104 Quail Trail, Unit B, Edgewood, NM 87015 | 2009-04-21 |
| 1033203419 | Judy H. Lui | Pediatrics | 1950-c Old Route 66, Edgewood, NM 87015 | 2006-10-03 |
| 1821050717 | Lesley Marie Weghorn | Pediatrics | 830 Thomas More Pkwy, Suite 200 A, Edgewood, KY 41017-5102 | 2006-04-05 |
| 1043283179 | Lisa Williams Miller | Pediatrics | 108 Beech Dr., Edgewood, KY 41017 | 2006-02-09 |
| 1194701045 | Griffith Ernest Quinby Jr. | Pediatrics | 233 Colony Dr., Edgewood, KY 41017-2636 | 2005-12-21 |
| 1386058923 | Adam William Reis | Pediatrics | 830 Thomas More Pkwy, Edgewood, KY 41017-5102 | 2014-06-11 |
| 1750453585 | Joya Heart | Pediatrics | 483 S Loop Rd, Edgewood, KY 41017-5446 | 2006-11-15 |
| 1760447619 | Jeffrey Thomas Janning | Pediatrics | 830 Thomas More Pkwy, Suite 200 A, Edgewood, KY 41017-5102 | 2006-04-20 |
| 1598739849 | Pediatric Care of Kentucky Psc | Pediatrics | 20 Medical Village Dr, Suite 102, Edgewood, KY 41017-5401 | 2006-02-14 |
| Find all providers in EDGEWOOD | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.