Healthcare Provider Details

I. General information

NPI: 1790147304
Provider Name (Legal Business Name): KRISTIN HEXTALL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2016
Last Update Date: 01/31/2025
Certification Date: 01/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1916 ROUTE 70 E STE 4
CHERRY HILL NJ
08003-2139
US

IV. Provider business mailing address

1916 ROUTE 70 E STE 4
CHERRY HILL NJ
08003-2139
US

V. Phone/Fax

Practice location:
  • Phone: 856-230-7684
  • Fax: 856-249-9427
Mailing address:
  • Phone: 856-230-7684
  • Fax: 856-249-9427

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN603891
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number26NR17986800
License Number StateNJ
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberSP015344
License Number StatePA
# 4
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number26NJ00626300
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: