Provider Demographics
NPI:1578720140
Name:BAMGARDNER, KRISTY NICOLE (CFA)
Entity Type:Individual
Prefix:
First Name:KRISTY
Middle Name:NICOLE
Last Name:BAMGARDNER
Suffix:
Gender:F
Credentials:CFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:590 BOULDER DR
Mailing Address - Street 2:
Mailing Address - City:ELIZABETHTOWN
Mailing Address - State:KY
Mailing Address - Zip Code:42701-5113
Mailing Address - Country:US
Mailing Address - Phone:270-234-9932
Mailing Address - Fax:270-234-9932
Practice Address - Street 1:590 BOULDER DR
Practice Address - Street 2:
Practice Address - City:ELIZABETHTOWN
Practice Address - State:KY
Practice Address - Zip Code:42701-5113
Practice Address - Country:US
Practice Address - Phone:270-234-9932
Practice Address - Fax:270-234-9932
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-20
Last Update Date:2008-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYSA151246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant