Provider Demographics
NPI:1033256110
Name:KEARFOTT, KITRINA LOU (MD)
Entity Type:Individual
Prefix:DR
First Name:KITRINA
Middle Name:LOU
Last Name:KEARFOTT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:234 MEDICAL CIR STE 1
Mailing Address - Street 2:
Mailing Address - City:MOREHEAD
Mailing Address - State:KY
Mailing Address - Zip Code:40351-1194
Mailing Address - Country:US
Mailing Address - Phone:606-784-6641
Mailing Address - Fax:606-783-7735
Practice Address - Street 1:234 MEDICAL CIR STE 1
Practice Address - Street 2:
Practice Address - City:MOREHEAD
Practice Address - State:KY
Practice Address - Zip Code:40351-1194
Practice Address - Country:US
Practice Address - Phone:606-674-6386
Practice Address - Fax:606-674-3096
Is Sole Proprietor?:No
Enumeration Date:2007-01-30
Last Update Date:2018-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY260963207Q00000X
KY26900207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64899461Medicaid