Provider Demographics
NPI:1700552585
Name:KINDERVATER, KASEY (APRN)
Entity Type:Individual
Prefix:
First Name:KASEY
Middle Name:
Last Name:KINDERVATER
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 1:48 AZTEC CT
Mailing Address - Street 2:
Mailing Address - City:ELIZABETHTOWN
Mailing Address - State:KY
Mailing Address - Zip Code:42701-4768
Mailing Address - Country:US
Mailing Address - Phone:127-073-5345
Mailing Address - Fax:
Practice Address - Street 1:2411 RING RD STE 114
Practice Address - Street 2:
Practice Address - City:ELIZABETHTOWN
Practice Address - State:KY
Practice Address - Zip Code:42701-5930
Practice Address - Country:US
Practice Address - Phone:270-706-1925
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-20
Last Update Date:2021-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3016275363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily