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General NPI Number Information
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NPI Number | 1275871907
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Entity Type | Organization
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Legal Business Name | KINGS DAUGHTERS MEDICAL SPECIALTIES INC
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Dates
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Enumeration Date | 01/31/2013
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Last Update Date | 10/09/2014
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Provider Practice Location Address
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Address Line | 1901 ARGONNE ROAD
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City | PORTSMOUTH
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State | OH
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Zip | 45662
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Country | US
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Telephone | 740-991-0911
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Fax | 740-991-6050
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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 | 606-408-6200
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Fax | 606-408-6612
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Authorized Official
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Title or Position | CEO/PRESIDENT
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Name | KRISTIE M WHITLATCH
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Credential |
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Telephone | 606-408-4401
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine 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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State | OH
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Taxonomy #4
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Taxonomy Code | 261QU0200X
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Taxonomy Name | Urgent Care Clinic/Center
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License Number |
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License Number State | OH
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