Provider Demographics
NPI:1417629213
Name:RAWLEY, KRISTIN CONRAD (APRN)
Entity Type:Individual
Prefix:MRS
First Name:KRISTIN
Middle Name:CONRAD
Last Name:RAWLEY
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1114 CHEROKEE RD
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40204-1202
Mailing Address - Country:US
Mailing Address - Phone:502-724-7600
Mailing Address - Fax:
Practice Address - Street 1:1114 CHEROKEE RD
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40204-1202
Practice Address - Country:US
Practice Address - Phone:502-724-7600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-30
Last Update Date:2021-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3016574363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily