Healthcare Provider Details

I. General information

NPI: 1508677402
Provider Name (Legal Business Name): CATHERINE MARY KENISTON WHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/20/2025
Last Update Date: 05/11/2025
Certification Date: 05/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35 MEDICAL CENTER PKWY
AUGUSTA ME
04330-8160
US

IV. Provider business mailing address

281 LOCUST RIDGE LN
ARNOLD MD
21012-1879
US

V. Phone/Fax

Practice location:
  • Phone: 207-621-9100
  • Fax:
Mailing address:
  • Phone: 410-703-6204
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License NumberRN2331738
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberCNP241161
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: