Healthcare Provider Details

I. General information

NPI: 1679127781
Provider Name (Legal Business Name): KW CONSULTING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/26/2019
Last Update Date: 09/30/2025
Certification Date: 09/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5966 SCOTTSVILLE RD
BOWLING GREEN KY
42104-0387
US

IV. Provider business mailing address

431 CLAYPOOL BOYCE RD
ALVATON KY
42122-8732
US

V. Phone/Fax

Practice location:
  • Phone: 270-791-8189
  • Fax:
Mailing address:
  • Phone: 270-791-8189
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: MRS. KRISTINA WATT FULLER
Title or Position: OWNER
Credential: LPCC
Phone: 270-791-8189