Healthcare Provider Details

I. General information

NPI: 1689839953
Provider Name (Legal Business Name): JANAE L KITTINGER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JANAE L MAHER MD

II. Dates (important events)

Enumeration Date: 07/25/2008
Last Update Date: 07/01/2021
Certification Date: 07/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2211 MAYFAIR DR STE 305
OWENSBORO KY
42301-4572
US

IV. Provider business mailing address

PO BOX 23229
OWENSBORO KY
42304-3229
US

V. Phone/Fax

Practice location:
  • Phone: 270-688-3700
  • Fax: 270-688-3709
Mailing address:
  • Phone: 270-688-1330
  • Fax: 270-688-1338

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number47263
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License Number47263
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: