Healthcare Provider Details

I. General information

NPI: 1164753687
Provider Name (Legal Business Name): SERENITY HEALTH CARE, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/22/2010
Last Update Date: 07/23/2023
Certification Date: 07/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1610 ARGILLITE RD
FLATWOODS KY
41139-1372
US

IV. Provider business mailing address

12955 STATE ROUTE 207
ARGILLITE KY
41121-8743
US

V. Phone/Fax

Practice location:
  • Phone: 888-756-4224
  • Fax: 888-258-5785
Mailing address:
  • Phone: 606-585-8486
  • Fax: 888-258-5785

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: KATHIE L WATSON-GRAY
Title or Position: OWNER
Credential: MD
Phone: 888-756-4224