Provider Demographics
NPI:1083214043
Name:MCGINNIS, KRISTA E (PMHNP)
Entity type:Individual
Prefix:
First Name:KRISTA
Middle Name:E
Last Name:MCGINNIS
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1881 WORCESTER RD STE 203
Mailing Address - Street 2:
Mailing Address - City:FRAMINGHAM
Mailing Address - State:MA
Mailing Address - Zip Code:01701-5410
Mailing Address - Country:US
Mailing Address - Phone:508-834-3183
Mailing Address - Fax:508-532-1168
Practice Address - Street 1:1881 WORCESTER RD STE 203
Practice Address - Street 2:
Practice Address - City:FRAMINGHAM
Practice Address - State:MA
Practice Address - Zip Code:01701-5410
Practice Address - Country:US
Practice Address - Phone:508-834-3183
Practice Address - Fax:508-532-1168
Is Sole Proprietor?:No
Enumeration Date:2020-10-29
Last Update Date:2023-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2294745163WP0809X, 364SP0810X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0810XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Child & Family
No163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult