Healthcare Provider Details

I. General information

NPI: 1902118789
Provider Name (Legal Business Name): KRISTIN P. BOOTHE APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KRISTIN P FERRELL APRN

II. Dates (important events)

Enumeration Date: 07/08/2010
Last Update Date: 09/14/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2609 NEW HARTFORD RD STE 3
OWENSBORO KY
42303-1316
US

IV. Provider business mailing address

PO BOX 21890
BELFAST ME
04915-4115
US

V. Phone/Fax

Practice location:
  • Phone: 812-476-7111
  • Fax: 812-476-7117
Mailing address:
  • Phone: 502-907-0356
  • Fax: 502-919-9780

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number3006532
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number1114048
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: