Provider Demographics
NPI:1548652704
Name:FAWCETT, KRISTIN M (NP)
Entity type:Individual
Prefix:
First Name:KRISTIN
Middle Name:M
Last Name:FAWCETT
Suffix:
Gender:F
Credentials:NP
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Mailing Address - Street 1:401 ROUTE 73 N BLDG 10, SUITE 320
Mailing Address - Street 2:
Mailing Address - City:MARLTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08053
Mailing Address - Country:US
Mailing Address - Phone:856-872-7055
Mailing Address - Fax:877-409-2156
Practice Address - Street 1:281 WITHERSPOON ST STE 200
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:NJ
Practice Address - Zip Code:08540-3224
Practice Address - Country:US
Practice Address - Phone:609-924-4892
Practice Address - Fax:877-409-2156
Is Sole Proprietor?:No
Enumeration Date:2015-02-25
Last Update Date:2025-05-31
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
DELM0000158363L00000X
NJ26NJ01006900363L00000X, 363LP0200X
NJ26NR13371500363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner