Healthcare Provider Details

I. General information

NPI: 1215268701
Provider Name (Legal Business Name): KRISTI LEIGH TINGLE WHNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/22/2010
Last Update Date: 12/03/2020
Certification Date: 12/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1023 NEW MOODY LN STE 103
LA GRANGE KY
40031-9177
US

IV. Provider business mailing address

2700 STANLEY GAULT PKWY SUITE 129
LOUISVILLE KY
40223-5132
US

V. Phone/Fax

Practice location:
  • Phone: 502-222-5558
  • Fax: 502-222-3040
Mailing address:
  • Phone: 502-253-4917
  • Fax: 502-489-5751

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number6257P
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: