Individual provider Active NPI

Kevin Joseph Kelly, MD

  • Pediatrics Physician
  • Edgewood, KY
National Provider Identifier
1417920554
Registry record updated Jul 13, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
26462 Issued in KY
Practice address
20 Medical Village Dr
Suite 102
Edgewood, KY 41017-5401
Phone
(859) 341-1011
Fax
(859) 341-7198
NPI assigned
Feb 9, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 13, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X 26462 KY Primary
Pediatrics Physician 208000000X 35055413 OH

Addresses

Primary practice location

20 Medical Village Dr
Suite 102
Edgewood, KY 41017-5401

Mailing address

20 Medical Village Dr
Suite 102
Edgewood, KY 41017-5401
Phone (859) 341-1011

Other identifiers 4

IdentifierTypeStateIssuer
000000033787OtherANTHEM
64264625MedicaidKY
1220585OtherOHUNITED HEALTH CARE
0637293OtherAETNA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
26462KYMDPediatrics Physician
35055413OHMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Pediatric Care of Kentucky PSC Pediatrics Past Accepting new patients

Interoperability endpoints

  • Direct secure messaging: kevin.kelly.p6@direct.cps.nextgenshare.com
  • Direct secure messaging: kevin.kelly.p6@direct.kypeds.nextgenshare.com

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1139443200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1783900800000",
    "number": "1417920554",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "20 MEDICAL VILLAGE DR",
            "address_2": "SUITE 102",
            "city": "EDGEWOOD",
            "state": "KY",
            "postal_code": "410175401",
            "telephone_number": "859-341-1011",
            "fax_number": "859-341-7198"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "20 MEDICAL VILLAGE DR",
            "address_2": "SUITE 102",
            "city": "EDGEWOOD",
            "state": "KY",
            "postal_code": "410175401",
            "telephone_number": "859-341-1011",
            "fax_number": "859-341-7198"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KELLY",
        "first_name": "KEVIN",
        "middle_name": "JOSEPH",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-02-09",
        "last_updated": "2026-07-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "KY",
            "license": "26462",
            "primary": true
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "OH",
            "license": "35055413",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM",
            "identifier": "000000033787",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "64264625",
            "state": "KY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED HEALTH CARE",
            "identifier": "1220585",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "0637293",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Edgewood, KY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.