Provider Demographics
NPI:1497083984
Name:AVILES, AMY KRISTEN (FNP)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:KRISTEN
Last Name:AVILES
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 1:3 ASTER PL
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01603-2201
Mailing Address - Country:US
Mailing Address - Phone:508-769-5875
Mailing Address - Fax:
Practice Address - Street 1:3 ASTER PL
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01603-2201
Practice Address - Country:US
Practice Address - Phone:508-769-5875
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-23
Last Update Date:2015-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN260678363LF0000X
NVAPN001296363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily