MEDICARE: MRS. KRISTAL LEDBETTER 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	363L00000X	Nurse Practitioner	APRN.CNP.0033736	OH
2	363LP2300X	Primary Care Nurse Practitioner	APRN.CNP.0033736	OH

General Provider Information

NPI Number	:	1467137018
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KRISTAL LEDBETTER FNP-C

Provider Business Mailing Address
First Line	:	8371 YANKEE ST
Second Line	:
City	:	CENTERVILLE
State	:	OH
Zip	:	45458-1810
Country	:	US
Telephone Number	:	866-844-5262
Fax Number	:

Provider Business Practice Location Address
First Line	:	8371 YANKEE ST
Second Line	:
City	:	CENTERVILLE
State	:	OH
Zip	:	45458-1810
Country	:	US
Telephone Number	:	937-844-5262
Fax Number	:

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

Provider Enumeration Date	:	06/21/2023
Last Update Date	:	09/26/2023

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