Provider Demographics
NPI:1407933187
Name:SHUTTS, KRISTY KATE (MD)
Entity Type:Individual
Prefix:
First Name:KRISTY
Middle Name:KATE
Last Name:SHUTTS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KRISTY
Other - Middle Name:KATE
Other - Last Name:MILLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 697
Mailing Address - Street 2:
Mailing Address - City:PRESTONSBURG
Mailing Address - State:KY
Mailing Address - Zip Code:41653-0697
Mailing Address - Country:US
Mailing Address - Phone:606-886-1173
Mailing Address - Fax:606-886-2193
Practice Address - Street 1:4851 KY ROUTE 321
Practice Address - Street 2:
Practice Address - City:PRESTONSBURG
Practice Address - State:KY
Practice Address - Zip Code:41653-9113
Practice Address - Country:US
Practice Address - Phone:606-886-1173
Practice Address - Fax:606-886-2193
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2019-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY39531208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64126451Medicaid
KY7100004160Medicaid