Provider Demographics
NPI:1558519850
Name:COMBS, KISHA LYNN
Entity Type:Individual
Prefix:MRS
First Name:KISHA
Middle Name:LYNN
Last Name:COMBS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6160 HIGHWAY 721
Mailing Address - Street 2:
Mailing Address - City:HAZARD
Mailing Address - State:KY
Mailing Address - Zip Code:41701-7095
Mailing Address - Country:US
Mailing Address - Phone:606-785-4789
Mailing Address - Fax:
Practice Address - Street 1:6160 HIGHWAY 721
Practice Address - Street 2:
Practice Address - City:HAZARD
Practice Address - State:KY
Practice Address - Zip Code:41701-7095
Practice Address - Country:US
Practice Address - Phone:606-785-4789
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-29
Last Update Date:2008-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor