Provider Demographics
NPI:1750087482
Name:STEVENSON, KRISTIN ALYSSA (CNP, RN)
Entity type:Individual
Prefix:MRS
First Name:KRISTIN
Middle Name:ALYSSA
Last Name:STEVENSON
Suffix:
Gender:F
Credentials:CNP, RN
Other - Prefix:
Other - First Name:KRISTIN
Other - Middle Name:ALYSSA
Other - Last Name:KELLY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2 LONG HILL LN
Mailing Address - Street 2:
Mailing Address - City:NORTH READING
Mailing Address - State:MA
Mailing Address - Zip Code:01864-2168
Mailing Address - Country:US
Mailing Address - Phone:978-457-5606
Mailing Address - Fax:
Practice Address - Street 1:55 FRUIT ST # 2
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114-2621
Practice Address - Country:US
Practice Address - Phone:617-726-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-03
Last Update Date:2023-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2287703363LP0200X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics