Individual
KYLE JAMISON CHILDERS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
3085 LAKECREST CIR, LEXINGTON, KY 40513-1707
(859) 258-8660
(859) 258-8610
Mailing address
3085 LAKECREST CIR, LEXINGTON, KY 40513-1707
(859) 258-8660
(859) 258-8610
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
37889
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
37903705
MEDICAID LAB GROUP
KY
01
—
4000501
MEDICARE LAB GROUP
KY
05
—
64066343
—
KY
01
—
CC4966
RR MEDICARE GROUP
GA
01
—
P00004985
RR MEDICARE PIN
GA
Enumeration date
07/03/2006
Last updated
09/16/2016
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