Provider Demographics
NPI:1073861191
Name:FOSS, KRISTINA MARIE (FNP)
Entity Type:Individual
Prefix:
First Name:KRISTINA
Middle Name:MARIE
Last Name:FOSS
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 706
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:NH
Mailing Address - Zip Code:03264-0706
Mailing Address - Country:US
Mailing Address - Phone:603-481-8757
Mailing Address - Fax:603-238-2163
Practice Address - Street 1:103 BOULDER POINT DR
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:NH
Practice Address - Zip Code:03264-3168
Practice Address - Country:US
Practice Address - Phone:603-536-1565
Practice Address - Fax:603-536-1200
Is Sole Proprietor?:No
Enumeration Date:2012-08-21
Last Update Date:2019-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH060970-23363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH3080081Medicaid
NH3080081Medicaid