Provider Demographics
NPI:1144710419
Name:WATHEN, KACI M (AUD)
Entity type:Individual
Prefix:DR
First Name:KACI
Middle Name:M
Last Name:WATHEN
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:KACI
Other - Middle Name:
Other - Last Name:EDWARDS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:101 PROSPEROUS PL STE 150
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40509-1868
Mailing Address - Country:US
Mailing Address - Phone:859-629-7140
Mailing Address - Fax:
Practice Address - Street 1:120 N EAGLE CREEK DR
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40509-1827
Practice Address - Country:US
Practice Address - Phone:859-629-7140
Practice Address - Fax:859-629-7137
Is Sole Proprietor?:No
Enumeration Date:2018-05-13
Last Update Date:2024-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
No231H00000XSpeech, Language and Hearing Service ProvidersAudiologist