Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | 3010742 | KY |
NPI | 1003366816 |
---|---|
Provider Name | Mrs. Kristine C Disibio |
First Address | Independence, KY 41051-8637 |
Second Address | Independence, KY 41051-8637 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/10/2016 |
Last Update Date | 05/10/2016 |