Provider Demographics
NPI:1477833903
Name:WARREN, KRISTI MARIE (FNP-BC)
Entity Type:Individual
Prefix:
First Name:KRISTI
Middle Name:MARIE
Last Name:WARREN
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 776351
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60677-6351
Mailing Address - Country:US
Mailing Address - Phone:502-588-9490
Mailing Address - Fax:502-272-5116
Practice Address - Street 1:210 E GRAY ST
Practice Address - Street 2:SUITE 701
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202-3900
Practice Address - Country:US
Practice Address - Phone:502-629-5225
Practice Address - Fax:502-629-5240
Is Sole Proprietor?:No
Enumeration Date:2011-08-29
Last Update Date:2022-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024169557363LF0000X
KY3007851363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000830441OtherANTHEM - NNS
KY150339OtherSIHO - NNS
KY50052820OtherPASSPORT - NNS
KY7100254280Medicaid
IN201203020Medicaid
KYK105130Medicare PIN