Provider Demographics
NPI:1386740348
Name:MARTIN, KRISTEN MARIA (ANPBC)
Entity type:Individual
Prefix:
First Name:KRISTEN
Middle Name:MARIA
Last Name:MARTIN
Suffix:
Gender:F
Credentials:ANPBC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 PROFESSIONAL DR STE 2B
Mailing Address - Street 2:
Mailing Address - City:SCARBOROUGH
Mailing Address - State:ME
Mailing Address - Zip Code:04074-8897
Mailing Address - Country:US
Mailing Address - Phone:207-761-1502
Mailing Address - Fax:207-774-2015
Practice Address - Street 1:300 PROFESSIONAL DR STE 2B
Practice Address - Street 2:
Practice Address - City:SCARBOROUGH
Practice Address - State:ME
Practice Address - Zip Code:04074-8897
Practice Address - Country:US
Practice Address - Phone:207-761-1502
Practice Address - Fax:207-774-2015
Is Sole Proprietor?:No
Enumeration Date:2006-09-16
Last Update Date:2025-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MERN39487163WR0006X
MECNP81798363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME432341799Medicaid
NH30346307Medicaid
NH30346307Medicaid
MENP548101Medicare PIN
ME432341799Medicaid
MEQ73328Medicare UPIN
MENP5481Medicare PIN