Provider Demographics
NPI:1982072856
Name:RHEAUME, KRISTEN JOAN (NP)
Entity Type:Individual
Prefix:MRS
First Name:KRISTEN
Middle Name:JOAN
Last Name:RHEAUME
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MS
Other - First Name:KRISTEN
Other - Middle Name:JOAN
Other - Last Name:BRADY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:PLYMOUTH PEDIATRIC ASSOCIATES
Mailing Address - Street 2:139 SANDWICH STREET
Mailing Address - City:PLYMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02360
Mailing Address - Country:US
Mailing Address - Phone:508-746-5900
Mailing Address - Fax:
Practice Address - Street 1:PLYMOUTH PEDIATRIC ASSOCIATES
Practice Address - Street 2:139 SANDWICH STREET
Practice Address - City:PLYMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02360
Practice Address - Country:US
Practice Address - Phone:508-746-5900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-09
Last Update Date:2019-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2283686363LP0200X
MARN2283686363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatricsGroup - Single Specialty