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General NPI Number Information
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NPI Number | 1861718199
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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 | 04/12/2010
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Last Update Date | 03/31/2022
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Provider Practice Location Address
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Address Line | 613 23RD ST STE 430
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City | ASHLAND
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State | KY
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Zip | 41101-2885
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Country | US
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Telephone | 606-408-8200
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Fax | 606-408-6291
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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 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 | 363LC0200X
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Taxonomy Name | Critical Care Medicine Nurse Practitioner
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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 | 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 | 363A00000X
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Taxonomy Name | Physician Assistant
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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 | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number |
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License Number State |
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