Healthcare Provider Details

I. General information

NPI: 1811833361
Provider Name (Legal Business Name): KRYSTAL LAFARA MUTTER APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/27/2026
Last Update Date: 04/27/2026
Certification Date: 04/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1184 GREEN VALLEY RD
GLASGOW KY
42141-8098
US

IV. Provider business mailing address

1184 GREEN VALLEY RD
GLASGOW KY
42141-8098
US

V. Phone/Fax

Practice location:
  • Phone: 270-454-0570
  • Fax:
Mailing address:
  • Phone: 270-454-0570
  • Fax: 888-759-3191

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code364SP0808X
TaxonomyPsychiatric/Mental Health Clinical Nurse Specialist
License Number1131522
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License Number1131522
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: