Provider Demographics
NPI:1003135948
Name:KINGSOLVER, WENDELL R (MD)
Entity Type:Individual
Prefix:
First Name:WENDELL
Middle Name:R
Last Name:KINGSOLVER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 SHEPHERDS HL
Mailing Address - Street 2:
Mailing Address - City:CARLISLE
Mailing Address - State:KY
Mailing Address - Zip Code:40311-9422
Mailing Address - Country:US
Mailing Address - Phone:859-289-5401
Mailing Address - Fax:859-289-5401
Practice Address - Street 1:200 SHEPHERDS HL
Practice Address - Street 2:
Practice Address - City:CARLISLE
Practice Address - State:KY
Practice Address - Zip Code:40311-9422
Practice Address - Country:US
Practice Address - Phone:859-289-5401
Practice Address - Fax:859-289-5401
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-17
Last Update Date:2010-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY11685207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine