| Kentucky Psychiatry, Llc | |
|
1300 Andrea St Suite 205 Bowling Green KY 42104-3382 | |
| (334) 239-2622 | |
| (334) 625-7602 |
| Full Name | Kentucky Psychiatry, Llc |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 1300 Andrea St, Bowling Green, Kentucky |
| Authorized Official Name and Position | Shankar Yalamanchili (OWNER) |
| Authorized Official Contact | 3342392622 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Kentucky Psychiatry, Llc 233 Winton Blount Loop Montgomery AL 36117-3507 Ph: (334) 239-2622 | Kentucky Psychiatry, Llc 1300 Andrea St Suite 205 Bowling Green KY 42104-3382 Ph: (334) 239-2622 |
| NPI Number | 1104358597 |
|---|---|
| Provider Enumeration Date | 04/03/2017 |
| Last Update Date | 04/03/2017 |
| Medicare PECOS PAC ID | 6002184389 |
|---|---|
| Medicare Enrollment ID | O20170608002297 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1104358597 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0800X | Psychiatry & Neurology - Psychiatry | (* (Not Available)) | Primary |
| 363LP0808X | Nurse Practitioner - Psychiatric/mental Health | (* (Not Available)) | Secondary |
| Provider Name | Max C Kinnaman |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1376693176 PECOS PAC ID: 7517909500 Enrollment ID: I20050601000034 |
| Provider Name | Michael John Light |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1508863648 PECOS PAC ID: 7214031699 Enrollment ID: I20070709000425 |
| Provider Name | Shelly D Champagne |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1548526049 PECOS PAC ID: 1850536954 Enrollment ID: I20130320000395 |
| Provider Name | Kimberly N Zimmerman |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1902146020 PECOS PAC ID: 4082843529 Enrollment ID: I20140204001021 |
| Provider Name | Cheryl R Gore |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1710375050 PECOS PAC ID: 6305157645 Enrollment ID: I20150612001476 |
| Provider Name | Phillip G Walker |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1881060754 PECOS PAC ID: 7012200926 Enrollment ID: I20160728002416 |
| Provider Name | Ronald L Mcgavic |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1649683640 PECOS PAC ID: 3678837861 Enrollment ID: I20180516002393 |
| Provider Name | Daltrey Anne Tyree |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1619968542 PECOS PAC ID: 7315134160 Enrollment ID: I20190510001929 |
| Provider Name | John Paul Palmer |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1851951818 PECOS PAC ID: 6204166325 Enrollment ID: I20191002002245 |
| Provider Name | Huma Qadir |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1932466885 PECOS PAC ID: 1557642352 Enrollment ID: I20200124002125 |
| Provider Name | Rachel Roberts |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1912545468 PECOS PAC ID: 4789013434 Enrollment ID: I20200401002551 |
| Provider Name | Brittany Ann Jackson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1477949576 PECOS PAC ID: 8729498878 Enrollment ID: I20201102001122 |
| Provider Name | Shane Mark Watts |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1285385005 PECOS PAC ID: 0345633368 Enrollment ID: I20220215000475 |
| Provider Name | Melissa S Werner |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1952060691 PECOS PAC ID: 6305214131 Enrollment ID: I20221128002887 |
| Provider Name | Brittany A Williams |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1639811102 PECOS PAC ID: 6305200403 Enrollment ID: I20230907002956 |
| Provider Name | Elisabeth B Sanderson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1467145367 PECOS PAC ID: 3274997242 Enrollment ID: I20230908001889 |
| Provider Name | Jared Stewart Roe |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1114270998 PECOS PAC ID: 7416172481 Enrollment ID: I20240123004279 |
Healing Path Counseling Mental Health Clinic Medicare: Medicare Enrolled Practice Location: 741 William Simmons Rd, Bowling Green, KY 42101 Phone: 270-202-1096 | |
The Luna Therapy & Wellness Center Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 2530 Scottsville Rd Ste 22, Bowling Green, KY 42104 Phone: 270-864-6872 | |
Restoration Counseling Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 1830 Destiny Ln, Bowling Green, KY 42104 Phone: 270-846-3222 Fax: 270-846-3228 | |
Casey Coursey Lcsw Emdr Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 410 E 10th Ave # 2c, Bowling Green, KY 42101 Phone: 364-203-8188 Fax: 949-437-3743 | |
Interventional Pain Specialists Of Bowling Green Plc Mental Health Clinic Medicare: Medicare Enrolled Practice Location: 165 Natchez Trace Ave, Suite 205, Bowling Green, KY 42103 Phone: 270-393-1912 Fax: 270-393-1913 | |
More To Life Counseling Llc Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 351 Pascoe Blvd, Suite 103h, Bowling Green, KY 42104 Phone: 270-791-5933 Fax: 270-721-0988 | |
Nurtured Counseling Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 109 Stoney Ct, Bowling Green, KY 42101 Phone: 270-200-0822 |