Provider Demographics
NPI:1427030766
Name:WURTH-FRAZIER, KIMBERLY (MD)
Entity Type:Individual
Prefix:MS
First Name:KIMBERLY
Middle Name:
Last Name:WURTH-FRAZIER
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 1:1698 OLD LEBANON RD
Mailing Address - Street 2:
Mailing Address - City:CAMPBELLSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42718-3319
Mailing Address - Country:US
Mailing Address - Phone:270-789-6087
Mailing Address - Fax:270-789-6119
Practice Address - Street 1:105 GREENBRIAR DR STE B
Practice Address - Street 2:
Practice Address - City:CAMPBELLSVILLE
Practice Address - State:KY
Practice Address - Zip Code:42718-9617
Practice Address - Country:US
Practice Address - Phone:270-465-3568
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-14
Last Update Date:2024-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY39011207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64078744Medicaid
1284108Medicare ID - Type Unspecified
I10118Medicare UPIN
KY64078744Medicaid
KY39011OtherLICENSE
KYP00343017OtherMEDICARE RR
7666618OtherAETNA
1284108Medicare ID - Type Unspecified