Provider Demographics
NPI:1366207938
Name:TODARELLO, KRYSTA MARIE (APRN-CNP)
Entity type:Individual
Prefix:
First Name:KRYSTA
Middle Name:MARIE
Last Name:TODARELLO
Suffix:
Gender:F
Credentials:APRN-CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 910866
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40591-0866
Mailing Address - Country:US
Mailing Address - Phone:859-605-2170
Mailing Address - Fax:859-605-2146
Practice Address - Street 1:705 S COLLEGE ST
Practice Address - Street 2:
Practice Address - City:HARRODSBURG
Practice Address - State:KY
Practice Address - Zip Code:40330-2105
Practice Address - Country:US
Practice Address - Phone:859-605-2170
Practice Address - Fax:859-605-2146
Is Sole Proprietor?:No
Enumeration Date:2024-02-14
Last Update Date:2024-10-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KY4016200363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner