Provider Demographics
NPI:1073912309
Name:DAWSON, KRISTINA LEIGH (APRN)
Entity Type:Individual
Prefix:
First Name:KRISTINA
Middle Name:LEIGH
Last Name:DAWSON
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:KRISTINA
Other - Middle Name:LEIGH
Other - Last Name:STALEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:6400 DUTCHMANS PKWY
Mailing Address - Street 2:SUITE 250
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40205-3354
Mailing Address - Country:US
Mailing Address - Phone:502-587-9660
Mailing Address - Fax:502-540-5615
Practice Address - Street 1:6400 DUTCHMANS PKWY
Practice Address - Street 2:SUITE 250
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40205-3354
Practice Address - Country:US
Practice Address - Phone:502-587-9660
Practice Address - Fax:502-540-5615
Is Sole Proprietor?:No
Enumeration Date:2014-08-22
Last Update Date:2015-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3008689363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily