Provider Demographics
NPI:1609699222
Name:SORRELS, KAILYN PHELPS
Entity type:Individual
Prefix:
First Name:KAILYN
Middle Name:PHELPS
Last Name:SORRELS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4041 LITTLE BLUESTEM DR
Mailing Address - Street 2:
Mailing Address - City:OWENSBORO
Mailing Address - State:KY
Mailing Address - Zip Code:42303-8304
Mailing Address - Country:US
Mailing Address - Phone:270-903-5755
Mailing Address - Fax:
Practice Address - Street 1:1605 SCHERM RD STE 3
Practice Address - Street 2:
Practice Address - City:OWENSBORO
Practice Address - State:KY
Practice Address - Zip Code:42301-5300
Practice Address - Country:US
Practice Address - Phone:270-903-5755
Practice Address - Fax:270-685-9443
Is Sole Proprietor?:No
Enumeration Date:2024-11-04
Last Update Date:2024-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYF09240735363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily