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General NPI Number Information
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NPI Number | 1508645359
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Entity Type | Organization
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Legal Business Name | KENTUCKY INTEGRATIVE AUTISM SPECIALIST
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Dates
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Enumeration Date | 09/21/2023
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Last Update Date | 09/02/2025
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Provider Practice Location Address
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Address Line | 416 MILLERSBURG RD
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City | PARIS
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State | KY
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Zip | 40361-2145
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Country | US
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Telephone | 859-592-4992
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Fax |
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Provider Business Mailing Address
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Address Line | 1750 THATCHERS MILL RD
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City | PARIS
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State | KY
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Zip | 40361-9110
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Country | US
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Telephone | 859-592-4992
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Fax |
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Authorized Official
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Title or Position | NP
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Name | TIFFANY BANKS
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Credential | APRN
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Telephone | 859-592-4992
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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 |
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License Number State |
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