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General NPI Number Information
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NPI Number | 1740763945
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Entity Type | Organization
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Legal Business Name | KINGS DAUGHTERS MEDICAL SPECIALTIES INTERVENTIONAL SPINE
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Dates
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Enumeration Date | 09/13/2018
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Last Update Date | 10/20/2023
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Provider Practice Location Address
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Address Line | 617 23RD ST STE 8B
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City | ASHLAND
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State | KY
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Zip | 41101-2845
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Country | US
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Telephone | 606-408-1290
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Fax | 606-408-6640
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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 | 606-408-1290
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Fax | 606-408-6640
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Authorized Official
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Title or Position | CEO/PRESDIENT
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Name | KRISTIE 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 | 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 | 111N00000X
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Taxonomy Name | Chiropractor
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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 | 207LP3000X
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Taxonomy Name | Pediatric Anesthesiology Physician
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License Number |
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License Number State |
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Taxonomy #4
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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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Taxonomy #5
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Taxonomy Code | 207LP2900X
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Taxonomy Name | Pain Medicine (Anesthesiology) Physician
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License Number |
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License Number State |
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