Healthcare Provider Details

I. General information

NPI: 1417886805
Provider Name (Legal Business Name): KRISTY N PETERSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/14/2026
Last Update Date: 05/14/2026
Certification Date: 05/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 GREYSTONE AVE
W SPRINGFIELD MA
01089-1910
US

IV. Provider business mailing address

220 GREYSTONE AVE
W SPRINGFIELD MA
01089-1910
US

V. Phone/Fax

Practice location:
  • Phone: 413-219-0665
  • Fax:
Mailing address:
  • Phone: 413-219-0665
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174N00000X
TaxonomyLactation Consultant (Non-RN)
License NumberALPP-306832
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: