MEDICARE: DR. KIERSTEN PROCTOR DNP, APRN, FNP-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	3015161	KY

General Provider Information

NPI Number	:	1295333219
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KIERSTEN PROCTOR DNP, APRN, FNP-C

Provider Business Mailing Address
First Line	:	20 MEDICAL VILLAGE DR STE 102
Second Line	:
City	:	EDGEWOOD
State	:	KY
Zip	:	41017-3490
Country	:	US
Telephone Number	:	859-341-1011
Fax Number	:	858-341-7198

Provider Business Practice Location Address
First Line	:	20 MEDICAL VILLAGE DR STE 102
Second Line	:
City	:	EDGEWOOD
State	:	KY
Zip	:	41017-3490
Country	:	US
Telephone Number	:	859-341-1011
Fax Number	:	858-341-7198

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/12/2020
Last Update Date	:	10/12/2020

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