Healthcare Provider Details

I. General information

NPI: 1497137947
Provider Name (Legal Business Name): KRISTOPHER W. WOLFE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2015
Last Update Date: 06/04/2024
Certification Date: 06/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1325 TRIPLETT ST # A
OWENSBORO KY
42303
US

IV. Provider business mailing address

PO BOX 23229
OWENSBORO KY
42304-3229
US

V. Phone/Fax

Practice location:
  • Phone: 270-686-8500
  • Fax: 270-685-5467
Mailing address:
  • Phone: 270-686-8500
  • Fax: 270-685-5467

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 StateNULL
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number51252
License Number StateKY
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberR3886
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: