Basic Information
| Provider Information | |||||||||
| NPI: | 1033256110 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KEARFOTT | ||||||||
| FirstName: | KITRINA | ||||||||
| MiddleName: | LOU | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 234 MEDICAL CIR STE 1 | ||||||||
| Address2: | |||||||||
| City: | MOREHEAD | ||||||||
| State: | KY | ||||||||
| PostalCode: | 403511194 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6067846641 | ||||||||
| FaxNumber: | 6067837735 | ||||||||
| Practice Location | |||||||||
| Address1: | 234 MEDICAL CIR STE 1 | ||||||||
| Address2: | |||||||||
| City: | MOREHEAD | ||||||||
| State: | KY | ||||||||
| PostalCode: | 403511194 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6066746386 | ||||||||
| FaxNumber: | 6066743096 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/30/2007 | ||||||||
| LastUpdateDate: | 02/28/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 260963 | NY | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | 26900 | KY | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 64899461 | 05 | KY | MEDICAID |