Provider Demographics
NPI:1982126843
Name:PARKER-KIST, DANA NICHOLE (APRN)
Entity Type:Individual
Prefix:
First Name:DANA
Middle Name:NICHOLE
Last Name:PARKER-KIST
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 1:200 MEDICAL VILLAGE DR
Mailing Address - Street 2:
Mailing Address - City:EDGEWOOD
Mailing Address - State:KY
Mailing Address - Zip Code:41017-3408
Mailing Address - Country:US
Mailing Address - Phone:859-301-2999
Mailing Address - Fax:859-301-2997
Practice Address - Street 1:4123 OLYMPIC BLVD STE 150
Practice Address - Street 2:
Practice Address - City:EDGEWOOD
Practice Address - State:KY
Practice Address - Zip Code:41018-3508
Practice Address - Country:US
Practice Address - Phone:859-301-2999
Practice Address - Fax:859-301-2997
Is Sole Proprietor?:No
Enumeration Date:2017-07-12
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3010870363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily