Provider Demographics
NPI:1164534038
Name:WIATR, KAY C (MD)
Entity Type:Individual
Prefix:DR
First Name:KAY
Middle Name:C
Last Name:WIATR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:4667 MATLOCK RD
Mailing Address - Street 2:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:KY
Mailing Address - Zip Code:42104-8712
Mailing Address - Country:US
Mailing Address - Phone:270-529-6271
Mailing Address - Fax:270-529-6271
Practice Address - Street 1:1719 NASHVILLE ST
Practice Address - Street 2:SUITE C
Practice Address - City:RUSSELLVILLE
Practice Address - State:KY
Practice Address - Zip Code:42276-8855
Practice Address - Country:US
Practice Address - Phone:270-726-7664
Practice Address - Fax:270-726-9997
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2008-03-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KY15401207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY6415401600Medicaid
KY1063501OtherINDIVIDUAL PROVIDER NUMBE
KY65929481Medicaid
KY0511703Medicare PIN
KYC69705Medicare UPIN