Kristen Kala Desandis, AG-ACNP, BC

Primary specialty

Critical Care Medicine Nurse PractitionerTaxonomy code 363LC0200X

License

549912241844 Issued in MA

Practice address

55 Fruit Street
Attn: Central Credentialing Office
Boston, MA 02114

Phone

(617) 726-2212

NPI assigned

Feb 10, 2022

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Kristen Kala Breem Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1644451200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1644451200000",
    "number": "1093469793",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11 REVERE ST APT 3",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "021143812",
            "telephone_number": "540-664-4846"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "55 FRUIT STREET",
            "address_2": "ATTN: CENTRAL CREDENTIALING OFFICE",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "02114",
            "telephone_number": "617-726-2212"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DESANDIS",
        "first_name": "KRISTEN",
        "middle_name": "KALA",
        "credential": "AG-ACNP, BC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-02-10",
        "last_updated": "2022-02-10",
        "certification_date": "2022-02-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LC0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Critical Care Medicine",
            "state": "MA",
            "license": "549912241844",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KRISTEN",
            "last_name": "BREEM",
            "middle_name": "KALA",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Sarishka Desai, MD
• Sonali Parekh Desai, M.D.
• Sukumar P Desai, MD
• Afomia Alemayehu Desalegn
• Matthew Nicholas Desalvo, M.D.
• Helen Desantis
• Sashawna Desarmes
• Selina Deschamps, MS BCBA LABA
• Daniel G. Deschler, M.D.
• Emoke Deschmann, M.D.

• Critical Care Medicine Nurse Practitioner in Boston, MA
• Providers in Boston, MA by specialty
• Critical Care Medicine Nurse Practitioner in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 10, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.