Provider Demographics
NPI:1790447175
Name:BRACKETT, KRISTIE LEE (NP)
Entity Type:Individual
Prefix:
First Name:KRISTIE
Middle Name:LEE
Last Name:BRACKETT
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:711 SAINT MARYS DR
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47714-0508
Mailing Address - Country:US
Mailing Address - Phone:812-476-4362
Mailing Address - Fax:
Practice Address - Street 1:711 SAINT MARYS DR
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47714-0508
Practice Address - Country:US
Practice Address - Phone:812-476-4362
Practice Address - Fax:812-469-3700
Is Sole Proprietor?:No
Enumeration Date:2021-10-12
Last Update Date:2022-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71011639A363LA2200X, 363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health