Provider Demographics
NPI:1770736878
Name:RICE, KRYSTAL M (APRN)
Entity type:Individual
Prefix:
First Name:KRYSTAL
Middle Name:M
Last Name:RICE
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:KRYSTAL
Other - Middle Name:M
Other - Last Name:HINKLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ARNP
Mailing Address - Street 1:PO BOX 909
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40201-0909
Mailing Address - Country:US
Mailing Address - Phone:502-629-8830
Mailing Address - Fax:502-629-7540
Practice Address - Street 1:210 EAST GRAY STREET
Practice Address - Street 2:STE 1000
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202-3906
Practice Address - Country:US
Practice Address - Phone:502-629-8830
Practice Address - Fax:502-629-7540
Is Sole Proprietor?:No
Enumeration Date:2008-11-03
Last Update Date:2024-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3005854363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100071660Medicaid
IN200942430Medicaid
IN200942430Medicaid
KYP400038014Medicare PIN
KY7100071660Medicaid