1518427459 NPI number — KRISTEN PREDMORE APRN, PMHNP-BC

Table of content: KRISTEN PREDMORE APRN, PMHNP-BC (NPI 1518427459)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1518427459 NPI number — KRISTEN PREDMORE APRN, PMHNP-BC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PREDMORE
Provider First Name:
KRISTEN
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
APRN, PMHNP-BC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
ASHE
Provider Other First Name:
KRISTEN
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1518427459
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/28/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 280
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PRESTONSBURG
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
41653-0280
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
606-349-7474
Provider Business Mailing Address Fax Number:
606-349-7737

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
842 E MOUNTAIN PKWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SALYERSVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
41465-8378
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-349-8100
Provider Business Practice Location Address Fax Number:
606-349-8150
Provider Enumeration Date:
03/25/2019

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LP0808X , with the licence number:  3013743 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 7100617960 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".




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