Provider Demographics
NPI:1932493657
Name:UPTON, KRISTIE C
Entity Type:Individual
Prefix:MRS
First Name:KRISTIE
Middle Name:C
Last Name:UPTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KRISTIE
Other - Middle Name:J
Other - Last Name:CAMPBELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:800 HIGHLANDER POINT DR
Mailing Address - Street 2:SUITE 204
Mailing Address - City:FLOYDS KNOBS
Mailing Address - State:IN
Mailing Address - Zip Code:47119-9465
Mailing Address - Country:US
Mailing Address - Phone:812-542-4921
Mailing Address - Fax:812-949-5966
Practice Address - Street 1:800 HIGHLANDER POINT DR
Practice Address - Street 2:SUITE 300
Practice Address - City:FLOYDS KNOBS
Practice Address - State:IN
Practice Address - Zip Code:47119-9465
Practice Address - Country:US
Practice Address - Phone:812-923-2273
Practice Address - Fax:812-923-4100
Is Sole Proprietor?:No
Enumeration Date:2011-05-31
Last Update Date:2020-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3006931363LF0000X
IN71004284A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201171540Medicaid
INM54226043Medicare PIN