Provider Demographics
NPI:1053021303
Name:KENTUCKY STUDENT SERVICES
Entity type:Organization
Organization Name:KENTUCKY STUDENT SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:
Authorized Official - Last Name:STIVERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-352-8896
Mailing Address - Street 1:211 BREIGHTON CIR STE 11A
Mailing Address - Street 2:
Mailing Address - City:SHELBYVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40065-8150
Mailing Address - Country:US
Mailing Address - Phone:502-352-8896
Mailing Address - Fax:502-633-0387
Practice Address - Street 1:211 BREIGHTON CIR STE 11A
Practice Address - Street 2:
Practice Address - City:SHELBYVILLE
Practice Address - State:KY
Practice Address - Zip Code:40065-8150
Practice Address - Country:US
Practice Address - Phone:502-352-8896
Practice Address - Fax:502-633-0387
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-28
Last Update Date:2022-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty