Provider Demographics
NPI:1962767095
Name:CAMPBELL, KRISTY LYNN (IECE)
Entity type:Individual
Prefix:MRS
First Name:KRISTY
Middle Name:LYNN
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:IECE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3942 HIGHWAY 1058
Mailing Address - Street 2:
Mailing Address - City:JAMESTOWN
Mailing Address - State:KY
Mailing Address - Zip Code:42629-6654
Mailing Address - Country:US
Mailing Address - Phone:270-343-4574
Mailing Address - Fax:270-343-4574
Practice Address - Street 1:3942 HIGHWAY 1058
Practice Address - Street 2:
Practice Address - City:JAMESTOWN
Practice Address - State:KY
Practice Address - Zip Code:42629-6654
Practice Address - Country:US
Practice Address - Phone:270-343-4574
Practice Address - Fax:270-343-4574
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-04
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
174H00000X
KY174H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator