Doctor Name: | MS. KRISTA AMY FENNEL |
NPI Number: | 1033398359 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | ARNP, CFNP |
License Number: | KY 4059P |
Business Practice Address: | 2501 Kentucky Ave Paducah, KY - 420033813 |
Business Phone Number: | 2705752180 |
Business Fax Number: | 2705758479 |
Mailing Address: | 2501 Kentucky Ave, PADUCAH |
State: | KY |
Postal Code: | 420033813 |
Phone Number: | 2705752180 |
Fax Number: | 2705758479 |
NPI Enumeration Date: | 11/02/2007 |
NPI Last Update Date: | 11/02/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | KY 4059P |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | KY |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |