Provider Demographics
NPI:1912995846
Name:HULEN, KRISTY LYNN (NP)
Entity Type:Individual
Prefix:
First Name:KRISTY
Middle Name:LYNN
Last Name:HULEN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 950202
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40295-0202
Mailing Address - Country:US
Mailing Address - Phone:502-588-9490
Mailing Address - Fax:502-272-5116
Practice Address - Street 1:1461 N GARDNER ST
Practice Address - Street 2:
Practice Address - City:SCOTTSBURG
Practice Address - State:IN
Practice Address - Zip Code:47170-7751
Practice Address - Country:US
Practice Address - Phone:502-584-2029
Practice Address - Fax:502-584-0873
Is Sole Proprietor?:No
Enumeration Date:2005-10-13
Last Update Date:2015-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71001829A363L00000X
KY4433P363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000796942OtherANTHEM - NCVA
KY7100164620OtherMEDICAID - NCVA
KY50044387OtherPASSPORT - NCVA
IN196290002OtherMEDICARE - NCVA
IN000000355237OtherANTHEM
IN200186940AMedicaid
KY141563OtherSIHO - NCVA
IN122000KMedicare ID - Type Unspecified
KY0282913Medicare ID - Type Unspecified
IN200186940AMedicaid
KYK073920Medicare PIN