Provider Demographics
NPI:1518633189
Name:NALL, KRISTEN NICOLE
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:NICOLE
Last Name:NALL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:318 TAYLOR ST
Mailing Address - Street 2:
Mailing Address - City:CLAY
Mailing Address - State:KY
Mailing Address - Zip Code:42404-2286
Mailing Address - Country:US
Mailing Address - Phone:270-635-1513
Mailing Address - Fax:
Practice Address - Street 1:724 HARVARD DR
Practice Address - Street 2:
Practice Address - City:OWENSBORO
Practice Address - State:KY
Practice Address - Zip Code:42301-6152
Practice Address - Country:US
Practice Address - Phone:270-929-9839
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-23
Last Update Date:2024-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN31008216A225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist