MEDICARE: KRISTEN L PRINCE FNP

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	695946	NY
2	363L00000X	Nurse Practitioner	F350733	NY
3	363LF0000X	Family Nurse Practitioner	350733	NY

General Provider Information

NPI Number	:	1770292948
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTEN L PRINCE FNP

Provider Business Mailing Address
First Line	:	822 ROUTE 82 STE 320
Second Line	:
City	:	HOPEWELL JUNCTION
State	:	NY
Zip	:	12533-7374
Country	:	US
Telephone Number	:	845-520-9904
Fax Number	:	845-579-2477

Provider Business Practice Location Address
First Line	:	822 ROUTE 82 STE 320
Second Line	:
City	:	HOPEWELL JUNCTION
State	:	NY
Zip	:	12533-7374
Country	:	US
Telephone Number	:	845-520-9904
Fax Number	:	845-579-2477

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

Provider Enumeration Date	:	11/16/2022
Last Update Date	:	03/28/2024

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