Healthcare Provider Details

I. General information

NPI: 1912469024
Provider Name (Legal Business Name): KARAH ELIZABETH MCDANIEL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/05/2019
Last Update Date: 07/20/2026
Certification Date: 07/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

548 WILL PKWY
VERSAILLES KY
40383-9294
US

IV. Provider business mailing address

548 WILL PKWY
VERSAILLES KY
40383-9294
US

V. Phone/Fax

Practice location:
  • Phone: 859-753-0583
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License NumberD-00087
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: