=====================================================
General NPI Number Information
=====================================================
NPI Number | 1497437461
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KRISTIN ANDREW FNP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/01/2023
-----------------------------------------------------
Last Update Date | 03/13/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 140 HOSPITAL DR STE 307
-----------------------------------------------------
City | BENNINGTON
-----------------------------------------------------
State | VT
-----------------------------------------------------
Zip | 05201-5018
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 802-442-9600
-----------------------------------------------------
Fax | 802-442-9687
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 25 GIFFORD LN
-----------------------------------------------------
City | EAGLE BRIDGE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 12057-2806
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 631-624-0698
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | 101.0136425
-----------------------------------------------------
License Number State | VT
-----------------------------------------------------