Provider Demographics
NPI:1811903230
Name:TAPPER, KRISTIE L (APRN)
Entity type:Individual
Prefix:MISS
First Name:KRISTIE
Middle Name:L
Last Name:TAPPER
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:112 LAFAYETTE STREET
Mailing Address - Street 2:
Mailing Address - City:NORWICH
Mailing Address - State:CT
Mailing Address - Zip Code:02169
Mailing Address - Country:US
Mailing Address - Phone:860-425-8715
Mailing Address - Fax:860-425-8707
Practice Address - Street 1:163 BROADWAY ST
Practice Address - Street 2:
Practice Address - City:COLCHESTER
Practice Address - State:CT
Practice Address - Zip Code:06415-1022
Practice Address - Country:US
Practice Address - Phone:860-537-4601
Practice Address - Fax:860-537-6935
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2012-01-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA2215133N00000X
CT004880363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No133N00000XDietary & Nutritional Service ProvidersNutritionist