Provider Demographics
NPI:1962921379
Name:DOUCETTE, KRYSTA L (MS, RN, AGNP-C)
Entity type:Individual
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First Name:KRYSTA
Middle Name:L
Last Name:DOUCETTE
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Gender:F
Credentials:MS, RN, AGNP-C
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Mailing Address - Street 1:47 HIGH STREET SUITE 101
Mailing Address - Street 2:
Mailing Address - City:NORTH ANDOVER
Mailing Address - State:MA
Mailing Address - Zip Code:01845-5201
Mailing Address - Country:US
Mailing Address - Phone:312-637-9861
Mailing Address - Fax:770-573-9513
Practice Address - Street 1:47 HIGH STREET SUITE 101
Practice Address - Street 2:
Practice Address - City:NORTH ANDOVER
Practice Address - State:MA
Practice Address - Zip Code:01845-5201
Practice Address - Country:US
Practice Address - Phone:312-637-9861
Practice Address - Fax:770-573-9513
Is Sole Proprietor?:No
Enumeration Date:2017-09-18
Last Update Date:2022-07-21
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MARN2280448363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology