Provider Demographics
NPI:1437312311
Name:EIDSON, KASEY MICHELLE (MD)
Entity Type:Individual
Prefix:DR
First Name:KASEY
Middle Name:MICHELLE
Last Name:EIDSON
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 1:312 JASON DR STE 9
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:KY
Mailing Address - Zip Code:40475-2785
Mailing Address - Country:US
Mailing Address - Phone:859-575-4075
Mailing Address - Fax:859-575-4126
Practice Address - Street 1:312 JASON DR STE 9
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:KY
Practice Address - Zip Code:40475-2785
Practice Address - Country:US
Practice Address - Phone:859-575-4075
Practice Address - Fax:859-575-4126
Is Sole Proprietor?:No
Enumeration Date:2008-07-09
Last Update Date:2023-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYR2530207Q00000X
KY47495207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine