Provider Demographics
NPI:1558779025
Name:CAMPOS, KRISTEN JENSEN (NP)
Entity Type:Individual
Prefix:MRS
First Name:KRISTEN
Middle Name:JENSEN
Last Name:CAMPOS
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 1:36 ROUND HILL RD
Mailing Address - Street 2:
Mailing Address - City:KINNELON
Mailing Address - State:NJ
Mailing Address - Zip Code:07405-3220
Mailing Address - Country:US
Mailing Address - Phone:973-492-1240
Mailing Address - Fax:
Practice Address - Street 1:36 ROUND HILL RD
Practice Address - Street 2:
Practice Address - City:KINNELON
Practice Address - State:NJ
Practice Address - Zip Code:07405-3220
Practice Address - Country:US
Practice Address - Phone:973-492-1240
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-29
Last Update Date:2014-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00513100363LA2200X
NYF306963-1363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health