Healthcare Provider Details

I. General information

NPI: 1992034490
Provider Name (Legal Business Name): KND DEVELOPMENT 59, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/11/2009
Last Update Date: 07/24/2020
Certification Date: 07/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 OAK ST ST
GREEN COVE SPRINGS FL
32043-4317
US

IV. Provider business mailing address

680 S 4TH ST
LOUISVILLE KY
40202-2407
US

V. Phone/Fax

Practice location:
  • Phone: 904-284-9230
  • Fax: 502-596-4150
Mailing address:
  • Phone: 502-596-7358
  • Fax: 833-501-9731

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number
License Number State

VIII. Authorized Official

Name: LINDA L FISHER
Title or Position: DVP REVENUE CYCLE
Credential:
Phone: 502-596-7358