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General NPI Number Information
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NPI Number | 1215085170
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Entity Type | Organization
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Legal Business Name | TRI STATE NEPHROLOGY PSC
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Dates
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Enumeration Date | 01/08/2007
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Last Update Date | 06/16/2008
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Provider Practice Location Address
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Address Line | 432 16TH ST SUITE B
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City | ASHLAND
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State | KY
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Zip | 41101-7693
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Country | US
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Telephone | 606-329-9335
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Fax | 606-324-6383
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Provider Business Mailing Address
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Address Line | PO BOX 2468
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City | ASHLAND
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State | KY
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Zip | 41105-2468
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Country | US
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Telephone | 606-329-9335
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Fax | 606-324-6383
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Authorized Official
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Title or Position | PRESIDENT
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Name | DONALD N HAMMONDS JR.
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Credential | DO
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Telephone | 606-329-9335
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 4797P
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License Number State | KY
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