Healthcare Provider Details

I. General information

NPI: 1285073874
Provider Name (Legal Business Name): KRISTINA P GUTIERREZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KRISTINA WELCH

II. Dates (important events)

Enumeration Date: 06/18/2013
Last Update Date: 07/13/2021
Certification Date: 07/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 WATERTOWER BYP
CAMPBELLSVILLE KY
42718-9010
US

IV. Provider business mailing address

130 SOUTHERN SCHOOL RD
SOMERSET KY
42501-3223
US

V. Phone/Fax

Practice location:
  • Phone: 270-465-4931
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: