Provider Demographics
NPI:1114032505
Name:PARIS, KRISTIE JONES (MD)
Entity Type:Individual
Prefix:
First Name:KRISTIE
Middle Name:JONES
Last Name:PARIS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KRISTIE
Other - Middle Name:GAY
Other - Last Name:JONES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 936
Mailing Address - Street 2:
Mailing Address - City:LONDON
Mailing Address - State:KY
Mailing Address - Zip Code:40743-0936
Mailing Address - Country:US
Mailing Address - Phone:606-330-7818
Mailing Address - Fax:606-330-7825
Practice Address - Street 1:4359 NEW SHEPHERDSVILLE RD UNIT 100
Practice Address - Street 2:
Practice Address - City:BARDSTOWN
Practice Address - State:KY
Practice Address - Zip Code:40004-8002
Practice Address - Country:US
Practice Address - Phone:502-350-5700
Practice Address - Fax:502-350-5701
Is Sole Proprietor?:No
Enumeration Date:2006-08-19
Last Update Date:2019-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01036696A2085R0001X
KY228082085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64228083Medicaid
IN100360110Medicaid
KY0515112Medicare PIN
IN1452501Medicare PIN
IN100360110Medicaid