Provider Demographics
NPI:1881640878
Name:PRESCOTT, KRISTEN M (MD, IBCLC, FAAP)
Entity Type:Individual
Prefix:DR
First Name:KRISTEN
Middle Name:M
Last Name:PRESCOTT
Suffix:
Gender:F
Credentials:MD, IBCLC, FAAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:874 PURCHASE ST
Mailing Address - Street 2:
Mailing Address - City:NEW BEDFORD
Mailing Address - State:MA
Mailing Address - Zip Code:02740-6232
Mailing Address - Country:US
Mailing Address - Phone:508-992-6553
Mailing Address - Fax:508-990-7558
Practice Address - Street 1:874 PURCHASE ST
Practice Address - Street 2:
Practice Address - City:NEW BEDFORD
Practice Address - State:MA
Practice Address - Zip Code:02740-6232
Practice Address - Country:US
Practice Address - Phone:508-992-6553
Practice Address - Fax:508-990-7558
Is Sole Proprietor?:No
Enumeration Date:2006-05-25
Last Update Date:2020-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND12361208000000X
MA284305208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH01YP02463NH02OtherANTHEM
NH30200835Medicaid
ND17085Medicaid
NHH18367Medicare UPIN
NDN720268Medicare PIN
NH01YP02463NH02OtherANTHEM