Healthcare Provider Details

I. General information

NPI: 1720548027
Provider Name (Legal Business Name): KRIS ACERET FNP, APRN-RX; RN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2019
Last Update Date: 03/21/2023
Certification Date: 03/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 SIXTH STREET
LANAI CITY HI
96763
US

IV. Provider business mailing address

220 HOOMALU ST
PEARL CITY HI
96782-2218
US

V. Phone/Fax

Practice location:
  • Phone: 808-565-6919
  • Fax: 808-565-9111
Mailing address:
  • Phone: 808-375-1924
  • Fax: 808-565-9111

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR-85336
License Number StateHI
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2739
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: