Provider Demographics
NPI:1831515303
Name:PERTUSET, KRISTEN (FNP-BC)
Entity type:Individual
Prefix:
First Name:KRISTEN
Middle Name:
Last Name:PERTUSET
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:KRISTEN
Other - Middle Name:ANN
Other - Last Name:LACOSTE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:100 INDIAN RIDGE DR STE 1
Mailing Address - Street 2:
Mailing Address - City:PIKETON
Mailing Address - State:OH
Mailing Address - Zip Code:45661-9654
Mailing Address - Country:US
Mailing Address - Phone:740-947-6480
Mailing Address - Fax:740-947-6482
Practice Address - Street 1:100 INDIAN RIDGE DR STE 1
Practice Address - Street 2:
Practice Address - City:PIKETON
Practice Address - State:OH
Practice Address - Zip Code:45661-9654
Practice Address - Country:US
Practice Address - Phone:740-947-6480
Practice Address - Fax:740-947-6482
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-08
Last Update Date:2022-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOA.15793-NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily