Provider Demographics
NPI:1508330499
Name:MARTIN, KRYSTLE BAYLON (NP-C)
Entity type:Individual
Prefix:
First Name:KRYSTLE
Middle Name:BAYLON
Last Name:MARTIN
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:171 W LOWRY LN STE 132
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40503-3006
Mailing Address - Country:US
Mailing Address - Phone:859-334-0484
Mailing Address - Fax:
Practice Address - Street 1:171 W LOWRY LN STE 132
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40503-3006
Practice Address - Country:US
Practice Address - Phone:859-334-0484
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-14
Last Update Date:2025-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYF01190666363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily