Healthcare Provider Details

I. General information

NPI: 1790964906
Provider Name (Legal Business Name): KRISTIE HIGDON RAILEY MS CCC/SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/24/2007
Last Update Date: 06/04/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 GENE CASH RD
CAMPBELLSVILLE KY
42718
US

IV. Provider business mailing address

385 WREN RD
BOWLING GREEN KY
42101-7448
US

V. Phone/Fax

Practice location:
  • Phone: 270-465-7768
  • Fax:
Mailing address:
  • Phone: 270-699-5271
  • Fax: 270-780-9757

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number07-011
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: