# KUTTAWA CLINIC, PLLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1184034951
- **Authorized official:** DR. DEBRA WILDER MD (MEMBER)
- **Authorized official phone:** (270) 853-8685

## Contact information

- **Practice address:** 91 CEDAR STREET, KUTTAWA, KY 42055
- **Practice address phone:** (270) 853-8685
- **Mailing address:** PO BOX 370, KUTTAWA, KY 42055-0370

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |
| 363LF0000X | Family Nurse Practitioner | 3009151 | KY | — |

## Other

- **Enumeration date:** 05/02/2014
- **Last updated:** 09/30/2020