Provider Demographics
NPI:1306042338
Name:EAGLES, KRISTY LEE (APRN)
Entity Type:Individual
Prefix:MRS
First Name:KRISTY
Middle Name:LEE
Last Name:EAGLES
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 SUNSET RD
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:MA
Mailing Address - Zip Code:01970-5319
Mailing Address - Country:US
Mailing Address - Phone:978-979-2957
Mailing Address - Fax:
Practice Address - Street 1:16 SUNSET RD
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:MA
Practice Address - Zip Code:01970-5319
Practice Address - Country:US
Practice Address - Phone:978-979-2957
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-26
Last Update Date:2022-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2270453363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health