Healthcare Provider Details

I. General information

NPI: 1033753520
Provider Name (Legal Business Name): KIM ANN ELDREDGE NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/29/2019
Last Update Date: 10/29/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 FERRY ST STE 313
CONCORD NH
03301-5004
US

IV. Provider business mailing address

3 KATIE LN
PELHAM NH
03076-2202
US

V. Phone/Fax

Practice location:
  • Phone: 860-788-6404
  • Fax:
Mailing address:
  • Phone: 603-548-9065
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number059863-23
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: