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General NPI Number Information
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NPI Number | 1780641415
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Entity Type | Individual
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Provider Name | JEREMY M KALTENBACH PA-C
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Gender | Male
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Dates
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Enumeration Date | 04/27/2006
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Last Update Date | 04/19/2018
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Provider Practice Location Address
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Address Line | 613 23RD ST STE G30
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City | ASHLAND
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State | KY
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Zip | 41101-2881
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Country | US
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Telephone | 606-327-0036
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Fax | 606-327-0036
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Provider Business Mailing Address
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Address Line | 2828 1ST AVE SUITE 400
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City | HUNTINGTON
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State | WV
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Zip | 25702-1236
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Country | US
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Telephone | 304-525-6905
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Fax | 304-525-4316
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 943
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License Number State | WV
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Taxonomy #2
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 00943
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License Number State | WV
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Taxonomy #3
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 50.001490
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License Number State | OH
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Taxonomy #4
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | PA1816
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License Number State | KY
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