Healthcare Provider Details

I. General information

NPI: 1902380082
Provider Name (Legal Business Name): RHEUMATOLOGY SPECIALISTS OF PADUCAH PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/24/2018
Last Update Date: 03/19/2026
Certification Date: 03/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 KIANA CT SUITE B
PADUCAH KY
42001-6767
US

IV. Provider business mailing address

100 KIANA CT SUITE B
PADUCAH KY
42001-6767
US

V. Phone/Fax

Practice location:
  • Phone: 270-408-6100
  • Fax: 270-408-6112
Mailing address:
  • Phone: 270-408-6100
  • Fax: 270-408-6112

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code332900000X
TaxonomyNon-Pharmacy Dispensing Site
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number
License Number State

VIII. Authorized Official

Name: HOLLY FERRELL
Title or Position: OFFICE MANAGER
Credential:
Phone: 270-408-6105