Healthcare Provider Details

I. General information

NPI: 1912995846
Provider Name (Legal Business Name): KRISTY LYNN HULEN NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/13/2005
Last Update Date: 11/06/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1461 N GARDNER ST
SCOTTSBURG IN
47170-7751
US

IV. Provider business mailing address

PO BOX 950202
LOUISVILLE KY
40295-0202
US

V. Phone/Fax

Practice location:
  • Phone: 502-584-2029
  • Fax: 502-584-0873
Mailing address:
  • Phone: 502-588-9490
  • Fax: 502-272-5116

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number71001829A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number4433P
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: