Provider Demographics
NPI:1679902753
Name:BUCK, KRISTIN ANNE (FNP-BC, APRN)
Entity type:Individual
Prefix:
First Name:KRISTIN
Middle Name:ANNE
Last Name:BUCK
Suffix:
Gender:F
Credentials:FNP-BC, APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:908 WALLACE AVE
Mailing Address - Street 2:
Mailing Address - City:LEITCHFIELD
Mailing Address - State:KY
Mailing Address - Zip Code:42754-1479
Mailing Address - Country:US
Mailing Address - Phone:270-259-9506
Mailing Address - Fax:270-259-4096
Practice Address - Street 1:912 WALLACE AVE
Practice Address - Street 2:
Practice Address - City:LEITCHFIELD
Practice Address - State:KY
Practice Address - Zip Code:42754-2404
Practice Address - Country:US
Practice Address - Phone:270-259-9506
Practice Address - Fax:270-259-4096
Is Sole Proprietor?:No
Enumeration Date:2013-11-08
Last Update Date:2019-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3008365363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100389060Medicaid