Healthcare Provider Details

I. General information

NPI: 1801250881
Provider Name (Legal Business Name): CHARLEIGH ARNOLD DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/06/2016
Last Update Date: 05/25/2021
Certification Date: 05/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 BLACK GOLD BLVD STE 106
HAZARD KY
41701-2620
US

IV. Provider business mailing address

PO BOX 959
HAZARD KY
41702-0959
US

V. Phone/Fax

Practice location:
  • Phone: 606-436-0711
  • Fax: 606-436-0848
Mailing address:
  • Phone: 606-436-0711
  • Fax: 606-436-0848

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number04844
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number04844
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: