Provider Demographics
NPI:1104517358
Name:EAST KENTUCKY PSYCHIATRIC CARE, LLC
Entity type:Organization
Organization Name:EAST KENTUCKY PSYCHIATRIC CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHIATRIC NURSE PRACTITIONER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KRISTIAN
Authorized Official - Middle Name:RENEE
Authorized Official - Last Name:ALLEN
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:606-359-1440
Mailing Address - Street 1:PO BOX 100
Mailing Address - Street 2:
Mailing Address - City:CAMPTON
Mailing Address - State:KY
Mailing Address - Zip Code:41301-0100
Mailing Address - Country:US
Mailing Address - Phone:606-225-2920
Mailing Address - Fax:
Practice Address - Street 1:72 ALLEN LN
Practice Address - Street 2:
Practice Address - City:CAMPTON
Practice Address - State:KY
Practice Address - Zip Code:41301-7899
Practice Address - Country:US
Practice Address - Phone:606-225-2920
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-18
Last Update Date:2023-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health