Healthcare Provider Details

I. General information

NPI: 1184912453
Provider Name (Legal Business Name): KINGS DAUGHTERS MEDICAL SPECIALTIES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/20/2011
Last Update Date: 07/19/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

613 23RD ST STE 130
ASHLAND KY
41101-2876
US

IV. Provider business mailing address

PO BOX 2379
ASHLAND KY
41105-2379
US

V. Phone/Fax

Practice location:
  • Phone: 606-329-9335
  • Fax: 606-324-6383
Mailing address:
  • Phone: 606-408-6200
  • Fax: 606-324-6612

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: KRISTIE M WHITLATCH
Title or Position: CEO/PRESIDENT
Credential:
Phone: 606-408-4401