Provider Demographics
NPI:1205351525
Name:ASSAD, KEIRSTEN (CNP)
Entity type:Individual
Prefix:
First Name:KEIRSTEN
Middle Name:
Last Name:ASSAD
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 STILES RD STE 202
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:NH
Mailing Address - Zip Code:03079-4802
Mailing Address - Country:US
Mailing Address - Phone:978-479-1892
Mailing Address - Fax:
Practice Address - Street 1:1 STILES RD STE 202
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:NH
Practice Address - Zip Code:03079-4802
Practice Address - Country:US
Practice Address - Phone:978-479-1892
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-08
Last Update Date:2022-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH067368-23363LF0000X
MARN2280128363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily