Provider Demographics
NPI:1700777604
Name:ADCOCK, KRISTINA ASHLEY (PSS)
Entity type:Individual
Prefix:
First Name:KRISTINA
Middle Name:ASHLEY
Last Name:ADCOCK
Suffix:
Gender:F
Credentials:PSS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:95 CIRCLE DR APT 8
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:KY
Mailing Address - Zip Code:41042-2432
Mailing Address - Country:US
Mailing Address - Phone:859-380-7102
Mailing Address - Fax:
Practice Address - Street 1:2001 MADISON AVE
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:KY
Practice Address - Zip Code:41014-1209
Practice Address - Country:US
Practice Address - Phone:859-444-4499
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-10
Last Update Date:2025-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist