Healthcare Provider Details

I. General information

NPI: 1548656630
Provider Name (Legal Business Name): KEVIN WHITE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/15/2015
Last Update Date: 02/01/2022
Certification Date: 02/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 TOWN AND COUNTRY LN STE 100
HAZARD KY
41701-9524
US

IV. Provider business mailing address

PO BOX 1988
HAZARD KY
41702-1988
US

V. Phone/Fax

Practice location:
  • Phone: 606-439-1300
  • Fax: 606-439-1400
Mailing address:
  • Phone: 606-439-1300
  • Fax: 606-439-1400

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number2018025910
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: