MEDICARE: KRISTEN ELIZABETH SHIRES APRN

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	363L00000X	Nurse Practitioner	11528	CT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1730885765
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTEN ELIZABETH SHIRES APRN

Provider Business Mailing Address
First Line	:	86 NEW LONDON TURNPIKE
Second Line	:
City	:	NORWICH
State	:	CT
Zip	:	06360
Country	:	US
Telephone Number	:	860-889-6967
Fax Number	:	860-885-1033

Provider Business Practice Location Address
First Line	:	86 NEW LONDON TURNPIKE
Second Line	:
City	:	NORWICH
State	:	CT
Zip	:	06360
Country	:	US
Telephone Number	:	860-889-6967
Fax Number	:	860-885-1033

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

Provider Enumeration Date	:	02/01/2023
Last Update Date	:	03/03/2026

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