Healthcare Provider Details

I. General information

NPI: 1720397409
Provider Name (Legal Business Name): KINGS DAUGHTERS MEDICAL SPECIALTIES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/29/2010
Last Update Date: 07/22/2024
Certification Date: 07/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

617 23RD ST STE 105
ASHLAND KY
41101-2890
US

IV. Provider business mailing address

PO BOX 2379
ASHLAND KY
41105-2379
US

V. Phone/Fax

Practice location:
  • Phone: 606-408-7500
  • Fax: 606-408-6600
Mailing address:
  • Phone: 606-408-2600
  • Fax: 606-408-2606

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number
License Number StateKY

VIII. Authorized Official

Name: SARA MARKS
Title or Position: CEO/PRESIDENT
Credential:
Phone: 606-408-4401