Provider Demographics
NPI:1689183014
Name:POULLIOT, KRISTY (FNP-BC)
Entity type:Individual
Prefix:MRS
First Name:KRISTY
Middle Name:
Last Name:POULLIOT
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:MISS
Other - First Name:KRISTY
Other - Middle Name:
Other - Last Name:POOLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:171 MAIN ST STE 203B
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:MA
Mailing Address - Zip Code:01721-1187
Mailing Address - Country:US
Mailing Address - Phone:508-881-3029
Mailing Address - Fax:508-881-1752
Practice Address - Street 1:29 HUDSON RD STE 3310
Practice Address - Street 2:
Practice Address - City:SUDBURY
Practice Address - State:MA
Practice Address - Zip Code:01776-1753
Practice Address - Country:US
Practice Address - Phone:978-443-8810
Practice Address - Fax:978-443-8839
Is Sole Proprietor?:No
Enumeration Date:2017-09-28
Last Update Date:2024-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2268086363LF0000X, 363L00000X
CT7330363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily