1912995846 NPI number — KRISTY LYNN HULEN NP

Table of content: (NPI 1104287762)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1912995846 NPI number — KRISTY LYNN HULEN NP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HULEN
Provider First Name:
KRISTY
Provider Middle Name:
LYNN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
NP
Provider Gender Code:
F

Provider's Other Name Information

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

NPI Number Information

NPI Number:
1912995846
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/06/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 950202
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LOUISVILLE
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
40295-0202
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
502-588-9490
Provider Business Mailing Address Fax Number:
502-272-5116

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1461 N GARDNER ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SCOTTSBURG
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
47170-7751
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-584-2029
Provider Business Practice Location Address Fax Number:
502-584-0873
Provider Enumeration Date:
10/13/2005

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: 363L00000X , with the licence number:  71001829A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 363L00000X , with the licence number: 4433P , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 000000796942 . This is a "ANTHEM - NCVA" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 7100164620 . This is a "MEDICAID - NCVA" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 50044387 . This is a "PASSPORT - NCVA" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 196290002 . This is a "MEDICARE - NCVA" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 000000355237 . This is a "ANTHEM" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 200186940A , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 141563 . This is a "SIHO - NCVA" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".




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