Provider Demographics
NPI:1568229698
Name:DOUCETTE, KRISTIN (APRN, PMHNP)
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:
Last Name:DOUCETTE
Suffix:
Gender:F
Credentials:APRN, PMHNP
Other - Prefix:
Other - First Name:KRISTIN
Other - Middle Name:
Other - Last Name:BAGLEY (MAIDEN NAME WAS FRIIS)
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:13040 KINGWOOD DR
Mailing Address - Street 2:
Mailing Address - City:BAXTER
Mailing Address - State:MN
Mailing Address - Zip Code:56425-8382
Mailing Address - Country:US
Mailing Address - Phone:218-851-4102
Mailing Address - Fax:
Practice Address - Street 1:811 2ND ST SE
Practice Address - Street 2:
Practice Address - City:LITTLE FALLS
Practice Address - State:MN
Practice Address - Zip Code:56345-3559
Practice Address - Country:US
Practice Address - Phone:320-631-7000
Practice Address - Fax:320-631-7229
Is Sole Proprietor?:No
Enumeration Date:2024-03-05
Last Update Date:2024-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN11348363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health