MEDICARE: KIRSTEN MARTIN

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	363LA2200X	Adult Health Nurse Practitioner	F311994	NY

General Provider Information

NPI Number	:	1871308825
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIRSTEN MARTIN

Provider Business Mailing Address
First Line	:	4055 VALLEY VIEW LN STE 700
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75244-5045
Country	:	US
Telephone Number	:	929-944-1576
Fax Number	:

Provider Business Practice Location Address
First Line	:	685 3RD AVE
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10017-4024
Country	:	US
Telephone Number	:	972-715-3800
Fax Number	:	972-715-3800

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

Provider Enumeration Date	:	02/07/2025
Last Update Date	:	02/07/2025

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Directions to “ KIRSTEN MARTIN ” Practice Location

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