Provider Demographics
NPI:1447330667
Name:STANFIELD, KRISTA (MSW)
Entity type:Individual
Prefix:
First Name:KRISTA
Middle Name:
Last Name:STANFIELD
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:520 VIOLET RD
Mailing Address - Street 2:
Mailing Address - City:CRITTENDEN
Mailing Address - State:KY
Mailing Address - Zip Code:41030-7480
Mailing Address - Country:US
Mailing Address - Phone:859-428-4100
Mailing Address - Fax:859-421-2134
Practice Address - Street 1:520 VIOLET RD
Practice Address - Street 2:
Practice Address - City:CRITTENDEN
Practice Address - State:KY
Practice Address - Zip Code:41030-7480
Practice Address - Country:US
Practice Address - Phone:859-428-4100
Practice Address - Fax:859-421-2134
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1650104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY184607Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER