Healthcare Provider Details

I. General information

NPI: 1609871581
Provider Name (Legal Business Name): TURNER WHITLEY & MORTON INTERNAL MEDICINE PSC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/16/2005
Last Update Date: 07/17/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1419 CUMBERLAND FALLS HWY
CORBIN KY
40701-2722
US

IV. Provider business mailing address

1419 CUMBERLAND FALLS HWY
CORBIN KY
40701-2722
US

V. Phone/Fax

Practice location:
  • Phone: 606-528-4481
  • Fax: 606-528-2857
Mailing address:
  • Phone: 606-528-4481
  • Fax: 606-528-2857

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number20474,23298,32248
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number StateKY
# 3
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number StateKY

VIII. Authorized Official

Name: MS. KATHY SHEPHERD
Title or Position: OFFICE MANAGER
Credential:
Phone: 606-528-4481