Provider Demographics
NPI:1093406928
Name:WATERS, KALI ANN (NP)
Entity type:Individual
Prefix:
First Name:KALI
Middle Name:ANN
Last Name:WATERS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:121 MEDICAL CENTER DR STE 2500
Mailing Address - Street 2:
Mailing Address - City:BRUNSWICK
Mailing Address - State:ME
Mailing Address - Zip Code:04011-2667
Mailing Address - Country:US
Mailing Address - Phone:207-373-6155
Mailing Address - Fax:207-808-7761
Practice Address - Street 1:121 MEDICAL CENTER DR STE 2500
Practice Address - Street 2:
Practice Address - City:BRUNSWICK
Practice Address - State:ME
Practice Address - Zip Code:04011-2667
Practice Address - Country:US
Practice Address - Phone:207-373-6155
Practice Address - Fax:207-808-7761
Is Sole Proprietor?:No
Enumeration Date:2023-05-19
Last Update Date:2025-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECNP231114363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner