Healthcare Provider Details

I. General information

NPI: 1740765957
Provider Name (Legal Business Name): KIDNEY SPECIALISTS OF PADUCAH PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2018
Last Update Date: 12/08/2023
Certification Date: 12/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1532 LONE OAK RD STE 315
PADUCAH KY
42003-7942
US

IV. Provider business mailing address

1532 LONE OAK RD STE 315
PADUCAH KY
42003-7942
US

V. Phone/Fax

Practice location:
  • Phone: 270-538-5880
  • Fax: 270-538-5870
Mailing address:
  • Phone: 270-538-5880
  • Fax: 270-538-5870

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code364SA2200X
TaxonomyAdult Health Clinical Nurse Specialist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. SHAUKAT ALI
Title or Position: MEMBER
Credential: MD
Phone: 270-538-5880