Provider Demographics
NPI:1477308963
Name:COTTON, KRISTEN L
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:L
Last Name:COTTON
Suffix:
Gender:X
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1153 BOUGHTON ST APT 6H
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:WI
Mailing Address - Zip Code:53094-3127
Mailing Address - Country:US
Mailing Address - Phone:262-722-3908
Mailing Address - Fax:
Practice Address - Street 1:1153 BOUGHTON ST APT 6H
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:WI
Practice Address - Zip Code:53094-3127
Practice Address - Country:US
Practice Address - Phone:262-722-3908
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-18
Last Update Date:2024-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI253Z00000X, 374J00000X, 376K00000X
WI366275376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes376K00000XNursing Service Related ProvidersNurse's Aide
No253Z00000XAgenciesIn Home Supportive Care
No374J00000XNursing Service Related ProvidersDoula