Provider Demographics
NPI:1700288388
Name:MERSHON, KRYSTAL (FNP-BC)
Entity type:Individual
Prefix:
First Name:KRYSTAL
Middle Name:
Last Name:MERSHON
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3A CATHY RD
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:01803-1242
Mailing Address - Country:US
Mailing Address - Phone:617-908-8089
Mailing Address - Fax:
Practice Address - Street 1:725 CONCORD AVE STE 3300
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02138-1055
Practice Address - Country:US
Practice Address - Phone:617-864-8822
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-25
Last Update Date:2021-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2283506363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care