MEDICARE: KRISTEN PERTUSET FNP-BC

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	363LF0000X	Family Nurse Practitioner	COA.15793-NP	OH

General Provider Information

NPI Number	:	1831515303
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTEN PERTUSET FNP-BC

Provider Business Mailing Address
First Line	:	100 INDIAN RIDGE DR STE 1
Second Line	:
City	:	PIKETON
State	:	OH
Zip	:	45661-9654
Country	:	US
Telephone Number	:	740-947-6480
Fax Number	:	740-947-6482

Provider Business Practice Location Address
First Line	:	100 INDIAN RIDGE DR STE 1
Second Line	:
City	:	PIKETON
State	:	OH
Zip	:	45661-9654
Country	:	US
Telephone Number	:	740-947-6480
Fax Number	:	740-947-6482

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

Provider Enumeration Date	:	03/08/2014
Last Update Date	:	11/07/2022

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