Kelly J Weddle, LMFT
Individual provider Active NPI Marriage & Family Therapist · Hodgenville, KY
NPI 1902123201 · NPPES record last updated Sep 1, 2023
Key facts
- NPI
- 1902123201
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Marriage & Family Therapist 106H00000X
- License
- 276325 (KY)
- Practice address
- 925 S Lincoln Blvd
Hodgenville, KY 42748-1701 - Phone
- (844) 435-0900
- Fax
- (270) 858-4029
- NPI assigned
- Apr 26, 2010
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 3
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in KY
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: No · Power mobility devices: No · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20231201000835 | KY | Practitioner - Marriage and Family Therapist | 2668820655 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 276325 | KY | MD | Marriage & Family Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Cumberland Family Medical Center Inc | Current |
Accepting new patients | |
| Cumberland Family Medical Center Inc | Current | Accepting new patients | |
| Cumberland Family Medical Center Inc | Current |
Accepting new patients |
Locations
360 Keen St
Burkesville, KY 42717
Phone (270) 864-1472
33 Eagle Ln
Hodgenville, KY 42748
Phone (270) 358-3506
925 S Lincoln Blvd
Hodgenville, KY 42748
Phone (270) 358-2210
2101 Lincoln Farm Rd
Hodgenville, KY 42748
Phone (270) 358-4112
911 S Lincoln Blvd
Hodgenville, KY 42748
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Marriage & Family Therapist | 106H00000X | 276325 | KY | Yes |
Addresses
Primary practice location
925 S Lincoln Blvd
Hodgenville, KY 42748-1701
Mailing address
PO Box 1080
Burkesville, KY 42717-1080
Phone (270) 858-6655
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 7100811660 | Medicaid | KY | |
| 15540976 | Other | KY | CAQH |
Other names
- Kelly J Black
Other providers in Hodgenville, KY
- Timeless Skin Studio, LLC
- Khue N Tran
- W I N G S Professional Consulting
- Walgreen Co
- Katherine Walsh
- Denise Whiteman
- Melissa D Whitt
All providers in Hodgenville, KY · Marriage & Family Therapist in Kentucky
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 1, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.