Provider Demographics
NPI:1497738546
Name:DESENSI, KRISTA M (MD)
Entity Type:Individual
Prefix:
First Name:KRISTA
Middle Name:M
Last Name:DESENSI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6801 DIXIE HWY
Mailing Address - Street 2:SUITE127
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40258-3913
Mailing Address - Country:US
Mailing Address - Phone:502-935-5633
Mailing Address - Fax:502-935-5706
Practice Address - Street 1:6801 DIXIE HWY
Practice Address - Street 2:SUITE127
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40258-3913
Practice Address - Country:US
Practice Address - Phone:502-935-5633
Practice Address - Fax:502-935-5706
Is Sole Proprietor?:No
Enumeration Date:2005-11-22
Last Update Date:2009-05-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KY37223208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000225825OtherBLUE SHIELD