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General NPI Number Information
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NPI Number | 1356664486
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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 | 03/03/2010
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Last Update Date | 02/16/2016
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Provider Practice Location Address
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Address Line | 1200 CENTRAL AVE STE 3
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City | ASHLAND
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State | KY
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Zip | 41101-7575
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Country | US
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Telephone | 606-325-1894
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Fax | 606-325-9193
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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 | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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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 | 207RE0101X
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Taxonomy Name | Endocrinology, Diabetes & Metabolism Physician
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License Number |
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License Number State |
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