Provider Demographics
NPI:1740220946
Name:FARRELL, KRISTOFFER (NP)
Entity Type:Individual
Prefix:
First Name:KRISTOFFER
Middle Name:
Last Name:FARRELL
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:KRIS
Other - Middle Name:
Other - Last Name:FARRELL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DNP, ACNP-BC,ENP-BC
Mailing Address - Street 1:265 BROOKVIEW CENTRE WAY
Mailing Address - Street 2:SUITE 400
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37919-4049
Mailing Address - Country:US
Mailing Address - Phone:800-342-2898
Mailing Address - Fax:
Practice Address - Street 1:265 BROOKVIEW CENTRE WAY
Practice Address - Street 2:SUITE 400
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37919-4049
Practice Address - Country:US
Practice Address - Phone:800-342-2898
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2023-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3007654363L00000X
WV83908363L00000X
PASP016124363L00000X
NY430977363L00000X
PASP007306363L00000X
CT7040363L00000X
NC5009909363L00000X
RI01365363L00000X
SC18933363L00000X
FL9467372363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA500028805OtherRAILROAD MEDICARE
NYMF3765407OtherDEA
PA500028805OtherRAILROAD MEDICARE
SCMF0828369OtherDEA
PA065574N46Medicare PIN