MEDICARE: MRS. KATHLEEN MARIE KRISTOPIK RNC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163WP0808X	Psychiatric/Mental Health Registered Nurse	RN29402	RI
2	163WP0808X	Psychiatric/Mental Health Registered Nurse	162260	MA
3	163W00000X	Registered Nurse	RN29402	RI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1245200195
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KATHLEEN MARIE KRISTOPIK RNC

Provider Business Mailing Address
First Line	:	14 URSULA DR
Second Line	:
City	:	BRISTOL
State	:	RI
Zip	:	02809-4352
Country	:	US
Telephone Number	:	401-253-6527
Fax Number	:

Provider Business Practice Location Address
First Line	:	530 N MAIN ST
Second Line	:
City	:	PROVIDENCE
State	:	RI
Zip	:	02904-5762
Country	:	US
Telephone Number	:	401-276-6175
Fax Number	:	401-276-4124

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/24/2006
Last Update Date	:	03/17/2018

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