Provider Demographics
NPI:1093406928
Name:WATERS, KALI ANN (NP)
Entity Type:Individual
Prefix:
First Name:KALI
Middle Name:ANN
Last Name:WATERS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27 LITTLE AVE APT 3
Mailing Address - Street 2:
Mailing Address - City:WESTBROOK
Mailing Address - State:ME
Mailing Address - Zip Code:04092-3379
Mailing Address - Country:US
Mailing Address - Phone:207-747-8066
Mailing Address - Fax:
Practice Address - Street 1:9 HEALTHCARE DR
Practice Address - Street 2:
Practice Address - City:BIDDEFORD
Practice Address - State:ME
Practice Address - Zip Code:04005-9449
Practice Address - Country:US
Practice Address - Phone:207-283-1427
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-19
Last Update Date:2023-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECNP231114363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner