Healthcare Provider Details

I. General information

NPI: 1609639327
Provider Name (Legal Business Name): KRISTEN NICOLE EADS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/05/2024
Last Update Date: 02/05/2024
Certification Date: 02/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1760 NICHOLASVILLE RD STE 301
LEXINGTON KY
40503-1472
US

IV. Provider business mailing address

502 HARPER GLN APT 302
NICHOLASVILLE KY
40356-6575
US

V. Phone/Fax

Practice location:
  • Phone: 859-277-6143
  • Fax:
Mailing address:
  • Phone: 859-321-7179
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: