Provider Demographics
NPI:1336409424
Name:MASSINGHAM, KRISTEN L (CPNP)
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:L
Last Name:MASSINGHAM
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:89 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ESSEX JUNCTION
Mailing Address - State:VT
Mailing Address - Zip Code:05452-3207
Mailing Address - Country:US
Mailing Address - Phone:802-879-6556
Mailing Address - Fax:802-872-8021
Practice Address - Street 1:89 MAIN ST
Practice Address - Street 2:
Practice Address - City:ESSEX JUNCTION
Practice Address - State:VT
Practice Address - Zip Code:05452-3207
Practice Address - Country:US
Practice Address - Phone:802-879-6556
Practice Address - Fax:802-872-8021
Is Sole Proprietor?:No
Enumeration Date:2012-05-22
Last Update Date:2023-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT101.0086381363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics