Kris Averell, MSOTR/L
Individual provider Active NPI Contractor · Prospect, KY
NPI 1043460413 · NPPES record last updated Sep 23, 2008
Key facts
- NPI
- 1043460413
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Contractor 171W00000X
- License
- KY-R3826 (KY)
- Practice address
- 3103 Ridgemoor CT
Prospect, KY 40059-8111 - Phone
- (502) 228-5776
- NPI assigned
- Sep 23, 2008
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| KY-R3826 | KY | MD | Contractor |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Contractor | 171W00000X | KY-R3826 | KY | Yes |
Addresses
Primary practice location
3103 Ridgemoor CT
Prospect, KY 40059-8111
Mailing address
3103 Ridgemoor CT
Prospect, KY 40059-8111
Phone (502) 228-5776
Other providers in Prospect, KY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 23, 2008. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.