Healthcare Provider Details

I. General information

NPI: 1679046239
Provider Name (Legal Business Name): KRISTIN WHIPPLE APRN, CNM, IBCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/07/2019
Last Update Date: 02/06/2023
Certification Date: 12/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 MEDICAL CENTER CIR
MAYFIELD KY
42066-1194
US

IV. Provider business mailing address

1111 MEDICAL CENTER CIR
MAYFIELD KY
42066-1194
US

V. Phone/Fax

Practice location:
  • Phone: 270-251-4543
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License NumberCNM08303
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License NumberL-141917
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: