Healthcare Provider Details

I. General information

NPI: 1013803626
Provider Name (Legal Business Name): CHRISTA ANN CARLIN APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2025
Last Update Date: 06/18/2025
Certification Date: 06/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

793 EASTERN BYP STE 201
RICHMOND KY
40475-2440
US

IV. Provider business mailing address

331 BECKAH DR
RICHMOND KY
40475-8326
US

V. Phone/Fax

Practice location:
  • Phone: 859-624-2229
  • Fax:
Mailing address:
  • Phone: 859-779-3640
  • Fax: 859-779-3640

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4041755
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: