Provider Demographics
NPI:1225214935
Name:KILCOYNE, KRISTY ANNA (PSYD)
Entity Type:Individual
Prefix:DR
First Name:KRISTY
Middle Name:ANNA
Last Name:KILCOYNE
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1700 KENTUCKY AVE STE 106
Mailing Address - Street 2:
Mailing Address - City:PADUCAH
Mailing Address - State:KY
Mailing Address - Zip Code:42003-7705
Mailing Address - Country:US
Mailing Address - Phone:270-442-0834
Mailing Address - Fax:270-442-0826
Practice Address - Street 1:1700 KENTUCKY AVE STE 106
Practice Address - Street 2:
Practice Address - City:PADUCAH
Practice Address - State:KY
Practice Address - Zip Code:42003-7705
Practice Address - Country:US
Practice Address - Phone:270-442-0834
Practice Address - Fax:270-442-0826
Is Sole Proprietor?:No
Enumeration Date:2008-01-11
Last Update Date:2008-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1493103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist