Healthcare Provider Details

I. General information

NPI: 1184742108
Provider Name (Legal Business Name): KID STEPS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/27/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

95 EDMONDS LANE
RUSSELL SPRINGS KY
42642-9529
US

IV. Provider business mailing address

PO BOX 385
RUSSELL SPRINGS KY
42642-0385
US

V. Phone/Fax

Practice location:
  • Phone: 270-866-7848
  • Fax: 270-866-7848
Mailing address:
  • Phone: 270-866-7848
  • Fax: 270-866-7848

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number1027282
License Number StateKY

VIII. Authorized Official

Name: MS. DELLA M KINCAID
Title or Position: PRIMARY SERVICE COORDINATOR FOR FIR
Credential: RN
Phone: 270-866-7848