Healthcare Provider Details

I. General information

NPI: 1649836206
Provider Name (Legal Business Name): KAITLYN PLANK BAIRD FERKO M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/18/2019
Last Update Date: 04/05/2024
Certification Date: 04/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 S PRESTON ST RM 305
LOUISVILLE KY
40202-1702
US

IV. Provider business mailing address

500 S PRESTON ST RM 305
LOUISVILLE KY
40202-1702
US

V. Phone/Fax

Practice location:
  • Phone: 502-852-8696
  • Fax:
Mailing address:
  • Phone: 502-852-8696
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number59127
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberR5720
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: