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General NPI Number Information
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NPI Number | 1184468639
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Entity Type | Organization
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Legal Business Name | KING'S DAUGHTERS MEDICAL SPECIALTIES, INC.
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Dates
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Enumeration Date | 06/20/2024
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Last Update Date | 06/20/2024
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Provider Practice Location Address
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Address Line | 1729 KINNEYS LN STE 101
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City | PORTSMOUTH
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State | OH
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Zip | 45662-3166
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Country | US
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Telephone | 740-529-2440
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Fax | 740-529-2442
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Provider Business Mailing Address
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Address Line | PO BOX 2379
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City | ASHLAND
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State | KY
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Zip | 41105-2379
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | SARA MARKS
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Credential |
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Telephone | 606-408-4000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 2084P0802X
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Taxonomy Name | Addiction Psychiatry Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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