Provider Demographics
NPI:1205422383
Name:LOCKETT-PUTMON, KRISTEN D'AUN (APRN, FNP-C)
Entity type:Individual
Prefix:MRS
First Name:KRISTEN
Middle Name:D'AUN
Last Name:LOCKETT-PUTMON
Suffix:
Gender:F
Credentials:APRN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1508 NW AVENUE D APT B2
Mailing Address - Street 2:
Mailing Address - City:BELLE GLADE
Mailing Address - State:FL
Mailing Address - Zip Code:33430-2867
Mailing Address - Country:US
Mailing Address - Phone:561-234-8165
Mailing Address - Fax:
Practice Address - Street 1:1508 NW AVENUE D APT B2
Practice Address - Street 2:
Practice Address - City:BELLE GLADE
Practice Address - State:FL
Practice Address - Zip Code:33430-2867
Practice Address - Country:US
Practice Address - Phone:561-234-8165
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-14
Last Update Date:2020-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9358446163W00000X
FL11005620363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner