Provider Demographics
NPI:1972936904
Name:FUSON, KRISTI (APN)
Entity type:Individual
Prefix:
First Name:KRISTI
Middle Name:
Last Name:FUSON
Suffix:
Gender:
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:240 N FREDERICK AVE
Mailing Address - Street 2:
Mailing Address - City:DAYTONA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32114-3400
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:240 N FREDERICK AVE
Practice Address - Street 2:
Practice Address - City:DAYTONA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32114-3400
Practice Address - Country:US
Practice Address - Phone:386-255-5569
Practice Address - Fax:218-543-8195
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-13
Last Update Date:2025-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4011314363LP0808X
IN71004553A363LP0808X
NE115613363LP0808X
NH113805-23363LP0808X
WAAP61673982363LP0808X
MT261273363LP0808X
OH0037856363LP0808X
IAG183803363LP0808X
FL9398002363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health