Provider Demographics
NPI:1477175156
Name:DAVIS, KRISTEN (APRN)
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:
Last Name:DAVIS
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 1:6076 MILLERSTOWN RD
Mailing Address - Street 2:
Mailing Address - City:CLARKSON
Mailing Address - State:KY
Mailing Address - Zip Code:42726-8133
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:20 E MCMURTRY AVE
Practice Address - Street 2:
Practice Address - City:HARTFORD
Practice Address - State:KY
Practice Address - Zip Code:42347-1647
Practice Address - Country:US
Practice Address - Phone:270-504-1300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-15
Last Update Date:2021-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1156850163W00000X
KY3016581363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY3016581OtherLICENSE