Healthcare Provider Details

I. General information

NPI: 1841295060
Provider Name (Legal Business Name): KRISTINALIN CALDWELL ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2005
Last Update Date: 01/22/2021
Certification Date: 01/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

305 ESTILL ST
BEREA KY
40403-1742
US

IV. Provider business mailing address

305 ESTILL ST
BEREA KY
40403-1742
US

V. Phone/Fax

Practice location:
  • Phone: 859-986-6527
  • Fax: 859-986-7355
Mailing address:
  • Phone: 859-986-6527
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number3003240
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number3003240P
License Number StateKY
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number3240P
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: