Healthcare Provider Details

I. General information

NPI: 1265396303
Provider Name (Legal Business Name): KRISTYNA WATSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KRISTYNA DEL VECCHIO

II. Dates (important events)

Enumeration Date: 12/12/2025
Last Update Date: 12/12/2025
Certification Date: 12/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

732 ELIZAVILLE AVE
FLEMINGSBURG KY
41041-1139
US

IV. Provider business mailing address

1624 MOUNT CARMEL RD
FLEMINGSBURG KY
41041-8389
US

V. Phone/Fax

Practice location:
  • Phone: 606-849-2323
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number1167704
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: