Healthcare Provider Details

I. General information

NPI: 1720772601
Provider Name (Legal Business Name): JUSTINE KAY CRAFT APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JUSTINE KAY PETERS

II. Dates (important events)

Enumeration Date: 06/05/2023
Last Update Date: 06/24/2025
Certification Date: 06/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 ROSE ST FL 1
LEXINGTON KY
40536-2843
US

IV. Provider business mailing address

800 ROSE ST FL 1
LEXINGTON KY
40536-7001
US

V. Phone/Fax

Practice location:
  • Phone: 859-562-1085
  • Fax: 859-257-5152
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LN0000X
TaxonomyNeonatal Nurse Practitioner
License Number4005389
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code363LN0005X
TaxonomyCritical Care Neonatal Nurse Practitioner
License Number4005389
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: