| Kuttawa Clinic, Pllc | |
|
91 Cedar Street Kuttawa KY 42055 | |
| (270) 853-8685 | |
| Not Available |
| Full Name | Kuttawa Clinic, Pllc |
|---|---|
| Speciality | Family Medicine |
| Location | 91 Cedar Street, Kuttawa, Kentucky |
| Authorized Official Name and Position | Debra Wilder (MEMBER) |
| Authorized Official Contact | 2708538685 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Kuttawa Clinic, Pllc Po Box 370 Kuttawa KY 42055-0370 Ph: () - | Kuttawa Clinic, Pllc 91 Cedar Street Kuttawa KY 42055 Ph: (270) 853-8685 |
| NPI Number | 1184034951 |
|---|---|
| Provider Enumeration Date | 05/02/2014 |
| Last Update Date | 09/30/2020 |
| Medicare PECOS PAC ID | 9133340466 |
|---|---|
| Medicare Enrollment ID | O20141029002068 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1184034951 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| 363LF0000X | Nurse Practitioner - Family | 3009151 (Kentucky) | Secondary |
| Provider Name | Debra Wilder |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1174513915 PECOS PAC ID: 2961546643 Enrollment ID: I20100218000498 |
| Provider Name | Elizabeth Skinner |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1861880221 PECOS PAC ID: 0244556637 Enrollment ID: I20150302001670 |
Lyon County Family Care Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 97 Lakeshore Dr, Kuttawa, KY 42055 Phone: 270-388-4357 |