Provider Demographics
NPI:1881640878
Name:PRESCOTT, KRISTEN M (MD, IBCLC, FAAP)
Entity type:Individual
Prefix:DR
First Name:KRISTEN
Middle Name:M
Last Name:PRESCOTT
Suffix:
Gender:F
Credentials:MD, IBCLC, FAAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 MILL RD
Mailing Address - Street 2:
Mailing Address - City:FAIRHAVEN
Mailing Address - State:MA
Mailing Address - Zip Code:02719-5252
Mailing Address - Country:US
Mailing Address - Phone:508-973-2000
Mailing Address - Fax:508-973-2001
Practice Address - Street 1:49 STATE RD STE 202
Practice Address - Street 2:
Practice Address - City:NORTH DARTMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02747-3322
Practice Address - Country:US
Practice Address - Phone:508-973-9240
Practice Address - Fax:508-973-0306
Is Sole Proprietor?:No
Enumeration Date:2006-05-25
Last Update Date:2024-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND12361208000000X
MA284305208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30200835Medicaid
NH01YP02463NH02OtherANTHEM
ND17085Medicaid
NHH18367Medicare UPIN
NDN720268Medicare PIN
NH01YP02463NH02OtherANTHEM