Healthcare Provider Details

I. General information

NPI: 1295967461
Provider Name (Legal Business Name): KIRSTEN LENORE BABCOCK PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KIRSTEN LENORE BABCOCK PA-C

II. Dates (important events)

Enumeration Date: 08/20/2009
Last Update Date: 06/25/2026
Certification Date: 06/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 MEDICAL VILLAGE DR
EDGEWOOD KY
41017-3403
US

IV. Provider business mailing address

PO BOX 932163
CLEVELAND OH
44193-0008
US

V. Phone/Fax

Practice location:
  • Phone: 859-301-2160
  • Fax:
Mailing address:
  • Phone: 610-477-6147
  • Fax: 302-440-5532

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA1861
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number50-002983
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: