Provider Demographics
NPI:1609104546
Name:COLE, LELA KRISTINE (ARNP)
Entity Type:Individual
Prefix:MRS
First Name:LELA
Middle Name:KRISTINE
Last Name:COLE
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 S 9TH ST
Mailing Address - Street 2:
Mailing Address - City:MAYFIELD
Mailing Address - State:KY
Mailing Address - Zip Code:42066-2208
Mailing Address - Country:US
Mailing Address - Phone:270-247-7795
Mailing Address - Fax:270-247-9013
Practice Address - Street 1:110 S 9TH ST
Practice Address - Street 2:
Practice Address - City:MAYFIELD
Practice Address - State:KY
Practice Address - Zip Code:42066-2208
Practice Address - Country:US
Practice Address - Phone:270-247-7795
Practice Address - Fax:270-247-9013
Is Sole Proprietor?:No
Enumeration Date:2009-12-04
Last Update Date:2015-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY6289P363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000644605OtherANTHEM BCBS
KY7100110690Medicaid
KY7100110690Medicaid
KY927906Medicare PIN