Provider Demographics
NPI:1912945437
Name:APPLEGATE, KIMBERLY ELAINE (MD)
Entity Type:Individual
Prefix:DR
First Name:KIMBERLY
Middle Name:ELAINE
Last Name:APPLEGATE
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 1:800 ROSE ST
Mailing Address - Street 2:STE HX314B
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40536-0293
Mailing Address - Country:US
Mailing Address - Phone:859-323-2105
Mailing Address - Fax:
Practice Address - Street 1:800 ROSE ST
Practice Address - Street 2:STE HX314B
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40536-0293
Practice Address - Country:US
Practice Address - Phone:859-323-2105
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-04
Last Update Date:2017-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYTP5882085P0229X
IN010468712085P0229X, 2085R0202X
KY499202085P0229X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085P0229XAllopathic & Osteopathic PhysiciansRadiologyPediatric Radiology
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200128730Medicaid
KY49920OtherKENTUCKY MEDICAL LICENSE
KY49920OtherKENTUCKY MEDICAL LICENSE
IN200128730Medicaid
IN219950RRMedicare PIN