Provider Demographics
NPI:1942299953
Name:DEPUYT, KRISTEN (NP)
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:
Last Name:DEPUYT
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 1:73 OAK RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:NEWFOUNDLAND
Mailing Address - State:NJ
Mailing Address - Zip Code:07435-1403
Mailing Address - Country:US
Mailing Address - Phone:973-663-1143
Mailing Address - Fax:973-810-3233
Practice Address - Street 1:73 OAK RIDGE RD
Practice Address - Street 2:
Practice Address - City:NEWFOUNDLAND
Practice Address - State:NJ
Practice Address - Zip Code:07435-1403
Practice Address - Country:US
Practice Address - Phone:973-663-1143
Practice Address - Fax:973-810-3233
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-21
Last Update Date:2021-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NN09821600363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJNN09821600OtherAPN LICENSE