Healthcare Provider Details

I. General information

NPI: 1982968533
Provider Name (Legal Business Name): WESTERN KENTUCKY ORTHOPAEDIC AND NEUROSURGICAL ASSOCIATES PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/28/2012
Last Update Date: 09/18/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

165 NATCHEZ TRACE AVE SUITE 200
BOWLING GREEN KY
42103-7940
US

IV. Provider business mailing address

165 NATCHEZ TRACE AVE SUITE 100
BOWLING GREEN KY
42103-7940
US

V. Phone/Fax

Practice location:
  • Phone: 270-782-7800
  • Fax: 270-783-5211
Mailing address:
  • Phone: 270-782-7800
  • Fax: 270-783-5211

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QX0100X
TaxonomyOccupational Medicine Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JACKIE WALKER
Title or Position: ADMINISTRATOR
Credential:
Phone: 270-782-7800