Provider Demographics
NPI:1174850812
Name:FRIEDRICH, KRISTIE NICKOLE (FNP)
Entity Type:Individual
Prefix:
First Name:KRISTIE
Middle Name:NICKOLE
Last Name:FRIEDRICH
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 S 8TH ST
Mailing Address - Street 2:SUITE 376 WEST
Mailing Address - City:MURRAY
Mailing Address - State:KY
Mailing Address - Zip Code:42071-2400
Mailing Address - Country:US
Mailing Address - Phone:270-762-1526
Mailing Address - Fax:270-762-1529
Practice Address - Street 1:300 S 8TH ST
Practice Address - Street 2:SUITE 376 WEST
Practice Address - City:MURRAY
Practice Address - State:KY
Practice Address - Zip Code:42071-2400
Practice Address - Country:US
Practice Address - Phone:270-762-1526
Practice Address - Fax:270-762-1529
Is Sole Proprietor?:No
Enumeration Date:2009-11-16
Last Update Date:2020-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK1340363LF0000X
TN14450363LF0000X
KY3008025363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3380640OtherMEDICAID GROUP
TN1517827Medicaid
TN3380640OtherMEDICARE GROUP
TN103I503974Medicare PIN