Healthcare Provider Details

I. General information

NPI: 1427750199
Provider Name (Legal Business Name): KAITLIN TIDMORE FERRELL MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2023
Last Update Date: 07/02/2026
Certification Date: 07/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1801 ASHLEY CIR
BOWLING GREEN KY
42104-3362
US

IV. Provider business mailing address

110 PICO CT
HENDERSONVILLE TN
37075-3919
US

V. Phone/Fax

Practice location:
  • Phone: 270-793-1000
  • Fax:
Mailing address:
  • Phone: 629-257-4815
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number62167
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: