MEDICARE: KRISTEN POWELL CRNA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	26NR17377000	NJ
2	367500000X	Certified Registered Nurse Anesthetist	26NJ01319000	NJ

General Provider Information

NPI Number	:	1285374975
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTEN POWELL CRNA

Provider Business Mailing Address
First Line	:	1 FEDERAL ST STE 200
Second Line	:
City	:	CAMDEN
State	:	NJ
Zip	:	08103-1088
Country	:	US
Telephone Number	:	848-288-6935
Fax Number	:

Provider Business Practice Location Address
First Line	:	94 OLD SHORT HILLS RD
Second Line	:
City	:	LIVINGSTON
State	:	NJ
Zip	:	07039-5672
Country	:	US
Telephone Number	:	973-322-5000
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/30/2022
Last Update Date	:	01/15/2026

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