Basic Information
| Provider Information | |||||||||
| NPI: | 1962921379 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DOUCETTE | ||||||||
| FirstName: | KRYSTA | ||||||||
| MiddleName: | L | ||||||||
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| Credential: | MS, RN, AGNP-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 47 HIGH STREET SUITE 101 | ||||||||
| Address2: | |||||||||
| City: | NORTH ANDOVER | ||||||||
| State: | MA | ||||||||
| PostalCode: | 018455201 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3126379861 | ||||||||
| FaxNumber: | 7705739513 | ||||||||
| Practice Location | |||||||||
| Address1: | 47 HIGH STREET SUITE 101 | ||||||||
| Address2: | |||||||||
| City: | NORTH ANDOVER | ||||||||
| State: | MA | ||||||||
| PostalCode: | 018455201 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3126379861 | ||||||||
| FaxNumber: | 7705739513 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/18/2017 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LG0600X | RN2280448 | MA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Gerontology |
No ID Information.