Healthcare Provider Details

I. General information

NPI: 1053150607
Provider Name (Legal Business Name): MRS. TAELYN EDISON KILGORE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/22/2024
Last Update Date: 05/04/2026
Certification Date: 05/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2150 LEXINGTON RD STE G
RICHMOND KY
40475-7924
US

IV. Provider business mailing address

1432 LOUISE DR
ASHLAND KY
41102-9619
US

V. Phone/Fax

Practice location:
  • Phone: 859-333-8147
  • Fax: 877-665-7294
Mailing address:
  • Phone: 606-776-5303
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number287187
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: