Healthcare Provider Details

I. General information

NPI: 1669231767
Provider Name (Legal Business Name): KATELYN BUSWELL FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/19/2024
Last Update Date: 03/19/2024
Certification Date: 02/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

677 COURT ST
KEENE NH
03431-1702
US

IV. Provider business mailing address

1222 NH ROUTE 119 APT 4
RINDGE NH
03461-6007
US

V. Phone/Fax

Practice location:
  • Phone: 603-357-3800
  • Fax:
Mailing address:
  • Phone: 603-313-5604
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number078514-23
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: