Kentucky Medical Spa

Primary specialty

Primary Care Clinic/CenterTaxonomy code 261QP2300X

License

14390 Issued in KY

Legal business name

KENTUCKY MEDICAL SPA

Practice address

636 Jefferson Ave
Paintsville, KY 41240-1349

Phone

(606) 788-1035

Fax

(606) 788-1045

NPI assigned

Sep 17, 2014

Organization subpart

No

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

Authorized official

Name

Dr. Jerry Brackett, M.D.

Title

President

Phone

(606) 788-1035

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1410912000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1410912000000",
    "number": "1326440637",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2710",
            "city": "PAINTSVILLE",
            "state": "KY",
            "postal_code": "412406710",
            "telephone_number": "606-788-1035",
            "fax_number": "606-788-1045"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "636 JEFFERSON AVE",
            "city": "PAINTSVILLE",
            "state": "KY",
            "postal_code": "412401349",
            "telephone_number": "606-788-1035",
            "fax_number": "606-788-1045"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KENTUCKY MEDICAL SPA",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-09-17",
        "last_updated": "2014-09-17",
        "status": "A",
        "authorized_official_last_name": "BRACKETT",
        "authorized_official_first_name": "JERRY",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "606-788-1035",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "KY",
            "license": "14390",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• K-VA-T Food Stores Inc
• Page Keeton, CADC
• Holli Kehler
• Kentucky Addiction Centers Paintsville, LLC
• Kentucky Institute for Eye Health & Surgery
• Yassin Khattab, M.D.
• Kings Daughters Medcial Specialties Inc
• Steven David Klamerus, M.D.
• Kitta Kousa, M.D.
• Loey J Kousa, MD

• Primary Care Clinic/Center in Paintsville, KY
• Providers in Paintsville, KY by specialty
• Primary Care Clinic/Center in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 17, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.