Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223E0200X | Endodontist | 937 | KY |
NPI | 1083848717 |
---|---|
Provider Name | Dr. Kevin Andrew Kerley |
First Address | Paducah, KY 42001-6717 |
Second Address | Paducah, KY 42001-6717 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/05/2009 |
Last Update Date | 11/01/2017 |