Provider Demographics
NPI:1669974515
Name:DUTTON, KRISTEN OSTERMAN (FNP)
Entity type:Individual
Prefix:
First Name:KRISTEN
Middle Name:OSTERMAN
Last Name:DUTTON
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 HEALTH PARK DR STE 220
Mailing Address - Street 2:
Mailing Address - City:GARNER
Mailing Address - State:NC
Mailing Address - Zip Code:27529-4685
Mailing Address - Country:US
Mailing Address - Phone:919-250-5955
Mailing Address - Fax:
Practice Address - Street 1:300 HEALTH PARK DR STE 220
Practice Address - Street 2:
Practice Address - City:GARNER
Practice Address - State:NC
Practice Address - Zip Code:27529-4685
Practice Address - Country:US
Practice Address - Phone:919-250-5955
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-07
Last Update Date:2025-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5019523363LF0000X
TN23808363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ072537Medicaid