Provider Demographics
NPI:1982640231
Name:EAKLE, KIMBERLY YVONNE (MD)
Entity Type:Individual
Prefix:DR
First Name:KIMBERLY
Middle Name:YVONNE
Last Name:EAKLE
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:PO BOX 1080
Mailing Address - Street 2:
Mailing Address - City:BURKESVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42717-1080
Mailing Address - Country:US
Mailing Address - Phone:270-864-1472
Mailing Address - Fax:270-864-1693
Practice Address - Street 1:102 RHODES ST
Practice Address - Street 2:
Practice Address - City:GAMALIEL
Practice Address - State:KY
Practice Address - Zip Code:42140-8942
Practice Address - Country:US
Practice Address - Phone:270-457-3000
Practice Address - Fax:270-457-2315
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2015-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY28800207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64288004Medicaid
TN4044637Medicaid
KY64288004Medicaid
TN3839274Medicare PIN
KYK183300Medicare PIN