Individual provider Active NPI

Judie Marie Kwolek, M.D.

  • Psychiatry Physician
  • Ashland, KY
National Provider Identifier
1386842813
Registry record updated May 6, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
License
252401 Issued in NY
Practice address
2201 Lexington Ave
Ashland, KY 41101-2843
Phone
(606) 408-4977
NPI assigned
Jul 5, 2007
Last updated
May 6, 2020By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 6, 2020

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry Physician 2084P0800X 78377 GA
Psychiatry Physician 2084P0800X DR.0064440 CO
Psychiatry Physician 2084P0800X T2020-116 AR
Psychiatry Physician 2084P0800X 252401 NY Primary

Addresses

Primary practice location

2201 Lexington Ave
Ashland, KY 41101-2843

Mailing address

2201 Lexington Ave
Ashland, KY 41101-2843
Phone (606) 408-4977

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20170823001537 GA Practitioner - Psychiatry 4981742574 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
T2020-116ARMDPsychiatry Physician
DR.0064440COMDPsychiatry Physician
78377GAMDPsychiatry Physician
252401NYMDPsychiatry Physician

Practice roles

OrganizationSpecialtyStatusNew patients
HHC St. Simons Inc CurrentSince Jun 25, 2017 Accepting new patients
Doctor on Demand Professionals P C Psychiatry Past Accepting new patients
Ashland Hospital Corporation Past Accepting new patients

Locations

2927 Demere Rd
St Simons Island, GA 31522
Phone (912) 638-1999

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1183593600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1588723200000",
    "number": "1386842813",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2201 LEXINGTON AVE",
            "city": "ASHLAND",
            "state": "KY",
            "postal_code": "411012843",
            "telephone_number": "606-408-4977"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2201 LEXINGTON AVE",
            "city": "ASHLAND",
            "state": "KY",
            "postal_code": "411012843",
            "telephone_number": "606-408-4977"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KWOLEK",
        "first_name": "JUDIE",
        "middle_name": "MARIE",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-07-05",
        "last_updated": "2020-05-06",
        "certification_date": "2020-05-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "GA",
            "license": "78377",
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "CO",
            "license": "DR.0064440",
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "AR",
            "license": "T2020-116",
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "NY",
            "license": "252401",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Ashland, KY

Sources for this page

Verify at the official NPI Registry.