Healthcare Provider Details

I. General information

NPI: 1851553978
Provider Name (Legal Business Name): KRISTA CAMP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KRISTA COOMES

II. Dates (important events)

Enumeration Date: 06/30/2008
Last Update Date: 06/03/2021
Certification Date: 06/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 WALNUT ST
OWENSBORO KY
42301-2956
US

IV. Provider business mailing address

PO BOX 1637
OWENSBORO KY
42302-1637
US

V. Phone/Fax

Practice location:
  • Phone: 270-689-6500
  • Fax:
Mailing address:
  • Phone: 270-689-6500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberKY-3407
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: