Provider Demographics
NPI:1265797724
Name:YOUTHER, KRISTIN R (FNP-BC)
Entity type:Individual
Prefix:
First Name:KRISTIN
Middle Name:R
Last Name:YOUTHER
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:702 STAFFORD DR
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:WV
Mailing Address - Zip Code:24740-2406
Mailing Address - Country:US
Mailing Address - Phone:304-425-0085
Mailing Address - Fax:304-487-6993
Practice Address - Street 1:702 STAFFORD DR
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:WV
Practice Address - Zip Code:24740-2406
Practice Address - Country:US
Practice Address - Phone:304-425-0085
Practice Address - Fax:304-487-6993
Is Sole Proprietor?:No
Enumeration Date:2012-07-11
Last Update Date:2025-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV58892363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily