MEDICARE: KID STEPS INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163WC0400X	Case Management Registered Nurse	1027282	KY

General Provider Information

NPI Number	:	1184742108
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KID STEPS INC

Provider Business Mailing Address
First Line	:	PO BOX 385
Second Line	:
City	:	RUSSELL SPRINGS
State	:	KY
Zip	:	42642-0385
Country	:	US
Telephone Number	:	270-866-7848
Fax Number	:	270-866-7848

Provider Business Practice Location Address
First Line	:	95 EDMONDS LANE
Second Line	:
City	:	RUSSELL SPRINGS
State	:	KY
Zip	:	42642-9529
Country	:	US
Telephone Number	:	270-866-7848
Fax Number	:	270-866-7848

Authorized Official
Title or Position	:	PRIMARY SERVICE COORDINATOR FOR FIR
Name	:	MS. DELLA M KINCAID
Credential	:	RN
Telephone Number	:	270-866-7848

Provider Enumeration Date	:	03/27/2007
Last Update Date	:	08/22/2020

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