Basic Information
| Provider Information | |||||||||
| NPI: | 1194923490 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KINGERY | ||||||||
| FirstName: | JOE | ||||||||
| MiddleName: | EAGLE | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 147 SYCAMORE ST | ||||||||
| Address2: | |||||||||
| City: | PIKEVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 415019118 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6062185446 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 184 S MAYO TRL | ||||||||
| Address2: | |||||||||
| City: | PIKEVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 415011518 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6064302213 | ||||||||
| FaxNumber: | 6064320336 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/07/2007 | ||||||||
| LastUpdateDate: | 04/08/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 04/08/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 03109 | KY | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.