Provider Demographics
NPI:1285139683
Name:PERRY, KRISTA LEIGH (DO)
Entity type:Individual
Prefix:DR
First Name:KRISTA
Middle Name:LEIGH
Last Name:PERRY
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:900 S LIMESTONE CTW 304
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40536-0293
Mailing Address - Country:US
Mailing Address - Phone:859-323-6642
Mailing Address - Fax:859-323-1200
Practice Address - Street 1:830 S LIMESTONE STE 304
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40536-0293
Practice Address - Country:US
Practice Address - Phone:859-323-0303
Practice Address - Fax:859-323-1200
Is Sole Proprietor?:No
Enumeration Date:2018-03-27
Last Update Date:2023-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY04974207R00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program