Provider Demographics
NPI:1518427459
Name:PREDMORE, KRISTEN (APRN, PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:
Last Name:PREDMORE
Suffix:
Gender:F
Credentials:APRN, PMHNP-BC
Other - Prefix:
Other - First Name:KRISTEN
Other - Middle Name:
Other - Last Name:ASHE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 280
Mailing Address - Street 2:
Mailing Address - City:PRESTONSBURG
Mailing Address - State:KY
Mailing Address - Zip Code:41653-0280
Mailing Address - Country:US
Mailing Address - Phone:606-349-7474
Mailing Address - Fax:606-349-7737
Practice Address - Street 1:842 E MOUNTAIN PKWY
Practice Address - Street 2:
Practice Address - City:SALYERSVILLE
Practice Address - State:KY
Practice Address - Zip Code:41465-8378
Practice Address - Country:US
Practice Address - Phone:606-349-8100
Practice Address - Fax:606-349-8150
Is Sole Proprietor?:No
Enumeration Date:2019-03-25
Last Update Date:2019-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3013743363LP0808X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100617960Medicaid