Healthcare Provider Details

I. General information

NPI: 1104043090
Provider Name (Legal Business Name): KEVIN HOWARD DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/20/2007
Last Update Date: 05/27/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2420 ARGILLITE RD
FLATWOODS KY
41139-1972
US

IV. Provider business mailing address

PO BOX 2155
ASHLAND KY
41105-2155
US

V. Phone/Fax

Practice location:
  • Phone: 606-836-3900
  • Fax: 606-836-0205
Mailing address:
  • Phone: 606-928-1881
  • Fax: 606-928-1776

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberKY03037
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: