Provider Demographics
NPI:1396151858
Name:FARRELL, KRISTEN M (APRN)
Entity type:Individual
Prefix:
First Name:KRISTEN
Middle Name:M
Last Name:FARRELL
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 1:1 QUAKERTOWN MDW
Mailing Address - Street 2:
Mailing Address - City:LEDYARD
Mailing Address - State:CT
Mailing Address - Zip Code:06339-1692
Mailing Address - Country:US
Mailing Address - Phone:401-497-2133
Mailing Address - Fax:
Practice Address - Street 1:85 SEYMOUR ST STE 1022
Practice Address - Street 2:
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06106-5530
Practice Address - Country:US
Practice Address - Phone:860-972-3570
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-05
Last Update Date:2025-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RINPP37882363LA2100X
CT005970363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT005970OtherAPRN LICENSE
CT1396151858Medicaid
RINPP37882OtherPROFESSIONAL LICENSE