Provider Demographics
NPI:1831655166
Name:BROUGHTON, KRISTINA (APRN)
Entity Type:Individual
Prefix:
First Name:KRISTINA
Middle Name:
Last Name:BROUGHTON
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1464 W CUMBERLAND GAP PKWY
Mailing Address - Street 2:
Mailing Address - City:CORBIN
Mailing Address - State:KY
Mailing Address - Zip Code:40701-5902
Mailing Address - Country:US
Mailing Address - Phone:606-280-4000
Mailing Address - Fax:
Practice Address - Street 1:1321 CUMBERLAND FALLS HWY STE 103
Practice Address - Street 2:
Practice Address - City:CORBIN
Practice Address - State:KY
Practice Address - Zip Code:40701-2861
Practice Address - Country:US
Practice Address - Phone:606-215-3144
Practice Address - Fax:606-467-2210
Is Sole Proprietor?:No
Enumeration Date:2019-02-12
Last Update Date:2022-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3013106363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY8820320211Medicaid