# KENTUCKY ADDICTION CENTERS PADUCAH LLC

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

## Provider details

- **NPI number:** 1962098822
- **Authorized official:** TROUPER KRUEGER (CSO-HHR)
- **Authorized official phone:** (979) 324-5456

## Contact information

- **Practice address:** 148 STUART NELSON PARK RD, PADUCAH, KY 42001-9678
- **Practice address phone:** (270) 908-2681
- **Mailing address:** 148 STUART NELSON PARK RD, PADUCAH, KY 42001-9678

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 101YA0400X | Addiction (Substance Use Disorder) Counselor | — | NULL | — |
| 101YA0400X | Addiction (Substance Use Disorder) Counselor | — | — | — |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |
| 207QA0401X | Addiction Medicine (Family Medicine) Physician | — | NULL | — |
| 207QA0401X | Addiction Medicine (Family Medicine) Physician | — | — | — |
| 363LF0000X | Family Nurse Practitioner | — | NULL | — |
| 363LF0000X | Family Nurse Practitioner | — | — | — |

## Other

- **Enumeration date:** 12/15/2020
- **Last updated:** 12/15/2020