=====================================================
General NPI Number Information
=====================================================
NPI Number | 1942299953
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KRISTEN DEPUYT NP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/21/2005
-----------------------------------------------------
Last Update Date | 12/30/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 73 OAK RIDGE RD
-----------------------------------------------------
City | NEWFOUNDLAND
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07435-1403
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 973-663-1143
-----------------------------------------------------
Fax | 973-810-3233
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 73 OAK RIDGE RD
-----------------------------------------------------
City | NEWFOUNDLAND
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07435-1403
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 973-663-1143
-----------------------------------------------------
Fax | 973-810-3233
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LP0200X
-----------------------------------------------------
Taxonomy Name | Pediatric Nurse Practitioner
-----------------------------------------------------
License Number | 26NN09821600
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------