Kuttawa Clinic, PLLC

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

KUTTAWA CLINIC, PLLC

Practice address

91 Cedar Street
Kuttawa, KY 42055

Phone

(270) 853-8685

NPI assigned

May 2, 2014

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Debra Wilder, MDNPI 1174513915

Title

Member

Phone

(270) 853-8685

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in KY

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Interoperability endpoints

• FHIR API: https://fhir4.healow.com/fhir/r4/GACICA

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Debra L. Wilder, M.D.

  • Family Medicine Physician
  • Kuttawa, KY
  • NPI 1174513915
  Medicare reassignment Care Compare group NPD Authorized official
• Elizabeth Skinner, APRN

  • Family Nurse Practitioner
  • Kuttawa, KY
  • NPI 1861880221
  Medicare reassignment Care Compare group NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1398988800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1601424000000",
    "number": "1184034951",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 370",
            "city": "KUTTAWA",
            "state": "KY",
            "postal_code": "420550370"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "91 CEDAR STREET",
            "city": "KUTTAWA",
            "state": "KY",
            "postal_code": "42055",
            "telephone_number": "270-853-8685"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KUTTAWA CLINIC, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-05-02",
        "last_updated": "2020-09-30",
        "certification_date": "2020-09-30",
        "status": "A",
        "authorized_official_last_name": "WILDER",
        "authorized_official_first_name": "DEBRA",
        "authorized_official_title_or_position": "MEMBER",
        "authorized_official_telephone_number": "270-853-8685",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": "KY",
            "license": "3009151",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Hilltop Nursing Home, Inc
• Hilltop Nursing Home, Inc.
• Gwendolyn Hinton, LPCA
• Damond Houston, LCSW
• Daniel K Jones, PSYD
• Landmark of Kuttawa a Rehabilitation & Nursing Center LL
• Lourdes Medical Pavilion, LLC
• Lyon Drug Store Inc
• Lyon Drug Store, Inc.
• Thomas G McConnell, R.PH.

• Family Medicine Physician in Kuttawa, KY
• Providers in Kuttawa, KY by specialty
• Family Medicine Physician in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 30, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.