Healthcare Provider Details

I. General information

NPI: 1497425177
Provider Name (Legal Business Name): ORTHOPAEDIC INSTITUTE OF WESTERN KENTUCKY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/15/2021
Last Update Date: 04/25/2022
Certification Date: 12/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 CLINT HILL BLVD
PADUCAH KY
42001-6768
US

IV. Provider business mailing address

PO BOX 415000 MSC 8336
NASHVILLE TN
37241-8336
US

V. Phone/Fax

Practice location:
  • Phone: 270-442-9461
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 7
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: BRIAN KERN
Title or Position: PRESIDENT
Credential: MD
Phone: 270-450-7102