Healthcare Provider Details

I. General information

NPI: 1275782328
Provider Name (Legal Business Name): THE ENDOCRINE AND DIABETES CENTER PSC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/13/2008
Last Update Date: 05/17/2022
Certification Date: 05/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 EAST PARRISH AVE. BUILDING E. SUITE 101
OWENSBORO KY
42303
US

IV. Provider business mailing address

2200 EAST PARRISH AVE. BUILDING E. SUITE 101
OWENSBORO KY
42303
US

V. Phone/Fax

Practice location:
  • Phone: 270-852-1655
  • Fax: 270-297-4962
Mailing address:
  • Phone: 270-852-1655
  • Fax: 270-297-4962

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number40781
License Number StateKY

VIII. Authorized Official

Name: MRS. KAREN EASTRIDGE
Title or Position: ADMINISTRATOR
Credential: DNP
Phone: 270-852-1655