Provider Demographics
NPI:1902213457
Name:KRATZWALD, KENDRA MOULTON (APRN)
Entity Type:Individual
Prefix:
First Name:KENDRA
Middle Name:MOULTON
Last Name:KRATZWALD
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:KENDRA
Other - Middle Name:
Other - Last Name:MOULTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:900 S LIMESTONE CTW320
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40536-0001
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:800 ROSE ST
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40536-2659
Practice Address - Country:US
Practice Address - Phone:859-323-0295
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-16
Last Update Date:2019-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3008777363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY0169Medicare PIN