Provider Demographics
NPI:1588934376
Name:MARSHALL, KRISTEN MARIE (PMHNP-BC)
Entity type:Individual
Prefix:
First Name:KRISTEN
Middle Name:MARIE
Last Name:MARSHALL
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1127 W LARONA LN
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85284-3760
Mailing Address - Country:US
Mailing Address - Phone:480-262-4067
Mailing Address - Fax:
Practice Address - Street 1:1127 W LARONA LN
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85284-3760
Practice Address - Country:US
Practice Address - Phone:480-262-4067
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-01-10
Last Update Date:2022-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP4414363LP0808X
AZRN126209101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health