Provider Demographics
NPI:1851457238
Name:KONSTANTINIDIS, MICHELLE (APRN)
Entity type:Individual
Prefix:MS
First Name:MICHELLE
Middle Name:
Last Name:KONSTANTINIDIS
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 MCLEOD LN
Mailing Address - Street 2:
Mailing Address - City:MADISONVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42431-3650
Mailing Address - Country:US
Mailing Address - Phone:270-245-2413
Mailing Address - Fax:
Practice Address - Street 1:11 MCLEOD LN
Practice Address - Street 2:
Practice Address - City:MADISONVILLE
Practice Address - State:KY
Practice Address - Zip Code:42431-3650
Practice Address - Country:US
Practice Address - Phone:270-245-2413
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-29
Last Update Date:2024-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4027026363LP0808X
TX686590163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse