Provider Demographics
NPI:1295599603
Name:COLE, KINDRA LEE (APRN)
Entity type:Individual
Prefix:MRS
First Name:KINDRA
Middle Name:LEE
Last Name:COLE
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:MS
Other - First Name:KINDRA
Other - Middle Name:LEE
Other - Last Name:WILSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5538 SOMERSET RD
Mailing Address - Street 2:
Mailing Address - City:LONDON
Mailing Address - State:KY
Mailing Address - Zip Code:40741-9696
Mailing Address - Country:US
Mailing Address - Phone:606-312-1479
Mailing Address - Fax:
Practice Address - Street 1:934 S LAUREL RD STE 2
Practice Address - Street 2:
Practice Address - City:LONDON
Practice Address - State:KY
Practice Address - Zip Code:40744-6314
Practice Address - Country:US
Practice Address - Phone:606-657-2030
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-07
Last Update Date:2024-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4012112363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily