=====================================================
General NPI Number Information
=====================================================
NPI Number | 1811833361
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KRYSTAL LAFARA MUTTER APRN
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/27/2026
-----------------------------------------------------
Last Update Date | 04/27/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1184 GREEN VALLEY RD
-----------------------------------------------------
City | GLASGOW
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 42141-8098
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 270-454-0570
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1184 GREEN VALLEY RD
-----------------------------------------------------
City | GLASGOW
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 42141-8098
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 270-454-0570
-----------------------------------------------------
Fax | 888-759-3191
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 364SP0808X
-----------------------------------------------------
Taxonomy Name | Psychiatric/Mental Health Clinical Nurse Specialist
-----------------------------------------------------
License Number | 1131522
-----------------------------------------------------
License Number State | KY
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 163WP0809X
-----------------------------------------------------
Taxonomy Name | Adult Psychiatric/Mental Health Registered Nurse
-----------------------------------------------------
License Number | 1131522
-----------------------------------------------------
License Number State | KY
-----------------------------------------------------