Annette M Kissin, NP

Primary specialty

Neonatal Nurse PractitionerTaxonomy code 363LN0000X

License

R032022 Issued in ME

Practice address

22 Bramhall St
Portland, ME 04102

Phone

(207) 662-2246

Fax

(207) 662-6227

NPI assigned

Dec 11, 2006

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

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

{
    "created_epoch": "1165795200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1532390400000",
    "number": "1295895456",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "22 BRAMHALL ST",
            "city": "PORTLAND",
            "state": "ME",
            "postal_code": "041023134"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "22 BRAMHALL ST",
            "city": "PORTLAND",
            "state": "ME",
            "postal_code": "04102",
            "telephone_number": "207-662-2246",
            "fax_number": "207-662-6227"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "6511 Spring Brook Ave",
            "address_purpose": "LOCATION",
            "city": "Rhinebeck",
            "state": "NY",
            "postal_code": "125723709",
            "country_code": "US",
            "telephone_number": "845-876-3001",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KISSIN",
        "first_name": "ANNETTE",
        "middle_name": "M",
        "name_prefix": "Ms.",
        "credential": "NP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-12-11",
        "last_updated": "2018-07-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LN0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Neonatal",
            "state": "NY",
            "license": "F350360",
            "primary": false
        },
        {
            "code": "363LN0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Neonatal",
            "state": "ME",
            "license": "R032022",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "03774449",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Jennifer L Kirsch, DO
• Kelly Ann Kirtland, DDS,MS,MA
• Rebecca S Kita, LCSW
• Carri Nix Kivela, M.S., N.P.-C.
• Rabee A Kiwan, MD
• Russell Scott Kizor, MD
• Andrea Shelley Klayman, M.D.

• All providers in Portland, ME
• Neonatal Nurse Practitioner in Maine

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 24, 2018; 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.