Healthcare Provider Details

I. General information

NPI: 1023608676
Provider Name (Legal Business Name): KRISTIN LEGRAND APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/18/2021
Last Update Date: 03/19/2025
Certification Date: 03/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 W 3RD ST
NEWPORT KY
41071-1814
US

IV. Provider business mailing address

PO BOX 635283
CINCINNATI OH
45263-5283
US

V. Phone/Fax

Practice location:
  • Phone: 859-578-5662
  • Fax: 859-261-3777
Mailing address:
  • Phone: 859-578-5662
  • Fax: 859-261-3777

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number3015335
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number3015335
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: