Healthcare Provider Details

I. General information

NPI: 1235996109
Provider Name (Legal Business Name): KRYSTEN AMANDA MILLETT NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/06/2024
Last Update Date: 11/25/2025
Certification Date: 11/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

361 OLD BELGRADE RD
AUGUSTA ME
04330-8058
US

IV. Provider business mailing address

361 OLD BELGRADE RD
AUGUSTA ME
04330-8058
US

V. Phone/Fax

Practice location:
  • Phone: 207-621-6100
  • Fax: 207-621-6102
Mailing address:
  • Phone: 207-621-6100
  • Fax: 207-621-6102

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberCNP241090
License Number StateME
# 2
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberCNP241090
License Number StateME
# 3
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberCNP241090
License Number StateME
# 4
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberCNP241090
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: