# KINGS DAUGHTERS MEDICAL SPECIALTIES INTERVENTIONAL SPINE

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

## Provider details

- **NPI number:** 1740763945
- **Authorized official:** KRISTIE WHITLATCH (CEO/PRESDIENT)
- **Authorized official phone:** (606) 408-4401

## Contact information

- **Practice address:** 617 23RD ST STE 8B, ASHLAND, KY 41101-2845
- **Practice address phone:** (606) 408-1290
- **Practice address fax:** (606) 408-6640
- **Mailing address:** PO BOX 2379, ASHLAND, KY 41105-2379
- **Mailing address phone:** (606) 408-1290
- **Mailing address fax:** (606) 408-6640

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1041C0700X | Clinical Social Worker | — | NULL | — |
| 1041C0700X | Clinical Social Worker | — | — | — |
| 111N00000X | Chiropractor | — | NULL | — |
| 111N00000X | Chiropractor | — | — | — |
| 207LP2900X | Pain Medicine (Anesthesiology) Physician | — | NULL | Yes |
| 207LP2900X | Pain Medicine (Anesthesiology) Physician | — | — | Yes |
| 207LP3000X | Pediatric Anesthesiology Physician | — | NULL | — |
| 207LP3000X | Pediatric Anesthesiology Physician | — | — | — |
| 363L00000X | Nurse Practitioner | — | NULL | — |
| 363L00000X | Nurse Practitioner | — | — | — |

## Other

- **Enumeration date:** 09/13/2018
- **Last updated:** 10/20/2023