Provider Demographics
NPI:1043819196
Name:MORETTI, KIMBERLY S (FNP-BC)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:S
Last Name:MORETTI
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:KIMBERLY
Other - Middle Name:S
Other - Last Name:CHRISTIE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:69 ROLLINGWOOD DR
Mailing Address - Street 2:
Mailing Address - City:JOHNSTON
Mailing Address - State:RI
Mailing Address - Zip Code:02919-1641
Mailing Address - Country:US
Mailing Address - Phone:774-644-5971
Mailing Address - Fax:
Practice Address - Street 1:107 SHERATON AVE
Practice Address - Street 2:
Practice Address - City:SOMERSET
Practice Address - State:MA
Practice Address - Zip Code:02725-1150
Practice Address - Country:US
Practice Address - Phone:774-644-5971
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-20
Last Update Date:2024-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2290052363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily