Provider Demographics
NPI:1245872787
Name:MACDONALD, KRISTIN EVELYN (FNP-BC)
Entity type:Individual
Prefix:
First Name:KRISTIN
Middle Name:EVELYN
Last Name:MACDONALD
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:KRISTIN
Other - Middle Name:EVELYN
Other - Last Name:MARTINIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:6 BLACKSTONE VALLEY PL STE 701
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:RI
Mailing Address - Zip Code:02865-1170
Mailing Address - Country:US
Mailing Address - Phone:401-333-3111
Mailing Address - Fax:
Practice Address - Street 1:6 BLACKSTONE VALLEY PL STE 701
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:RI
Practice Address - Zip Code:02865-1170
Practice Address - Country:US
Practice Address - Phone:401-333-3111
Practice Address - Fax:401-334-1217
Is Sole Proprietor?:No
Enumeration Date:2019-10-16
Last Update Date:2024-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIAPRN02280363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
RIAPRN02280OtherLICENSE