Provider Demographics
NPI:1689919862
Name:PEDIATRIC PARTNERS OF WESTERN KENTUCKY
Entity Type:Organization
Organization Name:PEDIATRIC PARTNERS OF WESTERN KENTUCKY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:BONNIE
Authorized Official - Middle Name:M
Authorized Official - Last Name:CASTLEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:270-926-8842
Mailing Address - Street 1:1102 TRIPLETT ST
Mailing Address - Street 2:STE. 1000
Mailing Address - City:OWENSBORO
Mailing Address - State:KY
Mailing Address - Zip Code:42303-3104
Mailing Address - Country:US
Mailing Address - Phone:270-926-8842
Mailing Address - Fax:270-926-0760
Practice Address - Street 1:1102 TRIPLETT ST
Practice Address - Street 2:STE. 1000
Practice Address - City:OWENSBORO
Practice Address - State:KY
Practice Address - Zip Code:42303-3104
Practice Address - Country:US
Practice Address - Phone:270-926-8842
Practice Address - Fax:270-926-0760
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-29
Last Update Date:2012-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Single Specialty