Provider Demographics
NPI:1881886323
Name:PENNEY, KRISTEN J (NURSE PRACTITIONER)
Entity type:Individual
Prefix:MRS
First Name:KRISTEN
Middle Name:J
Last Name:PENNEY
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:MISS
Other - First Name:KRISTEN
Other - Middle Name:J
Other - Last Name:LONG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:110 W SQUANTUM ST
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:MA
Mailing Address - Zip Code:02171-2122
Mailing Address - Country:US
Mailing Address - Phone:617-376-3000
Mailing Address - Fax:617-774-1906
Practice Address - Street 1:9 BICKNELL ST
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:MA
Practice Address - Zip Code:02169-6003
Practice Address - Country:US
Practice Address - Phone:617-471-4715
Practice Address - Fax:617-472-4977
Is Sole Proprietor?:No
Enumeration Date:2007-08-17
Last Update Date:2011-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA267907363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner