Healthcare Provider Details

I. General information

NPI: 1255593448
Provider Name (Legal Business Name): KRISTY MARIE LOVELL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/28/2008
Last Update Date: 06/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

731 BEE LICK CREEK RD
SOMERSET KY
42503-5249
US

IV. Provider business mailing address

731 BEE LICK CREEK RD
SOMERSET KY
42503-5249
US

V. Phone/Fax

Practice location:
  • Phone: 606-308-5455
  • Fax:
Mailing address:
  • Phone: 606-308-5455
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: