Healthcare Provider Details

I. General information

NPI: 1427030766
Provider Name (Legal Business Name): KIMBERLY WURTH-FRAZIER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/14/2005
Last Update Date: 03/14/2024
Certification Date: 03/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 GREENBRIAR DR STE B
CAMPBELLSVILLE KY
42718-9617
US

IV. Provider business mailing address

1698 OLD LEBANON RD
CAMPBELLSVILLE KY
42718-3319
US

V. Phone/Fax

Practice location:
  • Phone: 270-465-3568
  • Fax:
Mailing address:
  • Phone: 270-789-6087
  • Fax: 270-789-6119

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number39011
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: