Healthcare Provider Details

I. General information

NPI: 1578601597
Provider Name (Legal Business Name): CARLA A. KURTZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/02/2007
Last Update Date: 04/30/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 MEDICAL VILLAGE DR
EDGEWOOD KY
41017-3403
US

IV. Provider business mailing address

40 N GRAND AVE STE 103
FORT THOMAS KY
41075-1765
US

V. Phone/Fax

Practice location:
  • Phone: 859-301-5740
  • Fax: 859-301-5741
Mailing address:
  • Phone: 859-781-4900
  • Fax: 859-572-3035

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number0287
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number0737
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: