Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 11685 | KY |
NPI | 1003135948 |
---|---|
Provider Name | Wendell R. Kingsolver |
First Address | Carlisle, KY 40311-9422 |
Second Address | Carlisle, KY 40311-9422 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/05/2010 |
Last Update Date | 17/05/2010 |