Healthcare Provider Details

I. General information

NPI: 1457034787
Provider Name (Legal Business Name): KRISTEN MARIE RUSSELL NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2023
Last Update Date: 08/11/2023
Certification Date: 08/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 JEREMIAH V SULLIVAN DR
FALL RIVER MA
02721-6812
US

IV. Provider business mailing address

1920 COUNTY ST
SOMERSET MA
02726-5402
US

V. Phone/Fax

Practice location:
  • Phone: 508-672-0107
  • Fax:
Mailing address:
  • Phone: 508-269-8474
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN282284
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: