Individual
DR. KENNETH CHARLES IVERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
740 SOUTH LIMESTONE KENTUCKY CLINIC C300, LEXINGTON, KY 40536-0293
(859) 257-5405
(859) 257-5096
Mailing address
800 ROSE ST # C236, LEXINGTON, KY 40536-0293
(859) 257-5405
(859) 257-5096
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
48196
KY
207YP0228X
Pediatric Otolaryngology Physician
Primary
48196
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7100357020
—
KY
Enumeration date
06/29/2007
Last updated
10/28/2022
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