Basic Information
| Provider Information | |||||||||
| NPI: | 1578895066 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WARD | ||||||||
| FirstName: | KRISTEN | ||||||||
| MiddleName: | RENEE | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | C.N.M. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 719 RODEL CV STE 2015 | ||||||||
| Address2: | |||||||||
| City: | LAKE MARY | ||||||||
| State: | FL | ||||||||
| PostalCode: | 327465716 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4073023133 | ||||||||
| FaxNumber: | 4073304690 | ||||||||
| Practice Location | |||||||||
| Address1: | 719 RODEL CV | ||||||||
| Address2: | |||||||||
| City: | LAKE MARY | ||||||||
| State: | FL | ||||||||
| PostalCode: | 327465716 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4073023133 | ||||||||
| FaxNumber: | 4073304690 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/08/2010 | ||||||||
| LastUpdateDate: | 08/05/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/05/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367A00000X | ARNP3190672 | FL | Y | Physician Assistants & Advanced Practice Nursing Providers | Advanced Practice Midwife |
ID Information
| ID | Type | State | Issuer | Description | 003099500 | 05 | FL | MEDICAID |