Provider Demographics
NPI:1760802193
Name:RUNYON, KRISTEN (PNP)
Entity Type:Individual
Prefix:MS
First Name:KRISTEN
Middle Name:
Last Name:RUNYON
Suffix:
Gender:F
Credentials:PNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:503 CRANBURY RD
Mailing Address - Street 2:
Mailing Address - City:EAST BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08816-3612
Mailing Address - Country:US
Mailing Address - Phone:732-390-8400
Mailing Address - Fax:732-390-8970
Practice Address - Street 1:503 CRANBURY RD
Practice Address - Street 2:
Practice Address - City:EAST BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08816-3612
Practice Address - Country:US
Practice Address - Phone:732-390-8400
Practice Address - Fax:732-390-8970
Is Sole Proprietor?:No
Enumeration Date:2014-04-24
Last Update Date:2017-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00146700363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ26NJ00146700OtherADVANCED PRACTICE NURSE LICENSE
NJ26NR10598400OtherREGISTERED NURSE
NJ222694202OtherTIN