=====================================================
General NPI Number Information
=====================================================
NPI Number | 1609321801
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KAYLA KRISCENSKI NP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/18/2016
-----------------------------------------------------
Last Update Date | 06/06/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 44 DALE RD
-----------------------------------------------------
City | AVON
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06001-4315
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 860-674-8830
-----------------------------------------------------
Fax | 860-674-8984
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 44 DALE RD
-----------------------------------------------------
City | AVON
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06001-4320
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 860-674-8830
-----------------------------------------------------
Fax | 860-674-8984
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363L00000X
-----------------------------------------------------
Taxonomy Name | Nurse Practitioner
-----------------------------------------------------
License Number | RN2265093
-----------------------------------------------------
License Number State | MA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 363LA2200X
-----------------------------------------------------
Taxonomy Name | Adult Health Nurse Practitioner
-----------------------------------------------------
License Number | 8811
-----------------------------------------------------
License Number State | CT
-----------------------------------------------------