Provider Demographics
NPI:1124130059
Name:MEYER, KRISTIN L (APRN)
Entity type:Individual
Prefix:MRS
First Name:KRISTIN
Middle Name:L
Last Name:MEYER
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 BRAEBURN RD
Mailing Address - Street 2:
Mailing Address - City:WEST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06107-1605
Mailing Address - Country:US
Mailing Address - Phone:802-299-1527
Mailing Address - Fax:
Practice Address - Street 1:631 QUAKER LN S
Practice Address - Street 2:
Practice Address - City:WEST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06110-1026
Practice Address - Country:US
Practice Address - Phone:860-233-5133
Practice Address - Fax:860-233-5212
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2017-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH051739-23-05363LA2200X
CT4495363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1010077Medicaid
VT1010077Medicaid
Q00881Medicare UPIN