Individual provider Active NPI

Kristen Mara Tait, AGACNP-BC

  • Acute Care Nurse Practitioner
  • Philadelphia, PA
National Provider Identifier
1629749056
Registry record updated Feb 13, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Acute Care Nurse PractitionerTaxonomy code 363LA2100X
License
95017307 Issued in CA
Practice address
51 N 39TH St
Philadelphia, PA 19104-2640
Phone
(215) 662-9000
NPI assigned
Sep 24, 2021
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 13, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Acute Care Nurse Practitioner 363LA2100X 95017307 CA Primary

Addresses

Primary practice location

51 N 39TH St
Philadelphia, PA 19104-2640

Mailing address

5767 W Century Blvd Ste 400
Los Angeles, CA 90045-5631

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA, NJ2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20240212002776 PA Practitioner - Nurse Practitioner 4880083567 Reassigns benefits to 1 organization
I20250926003014 NJ Practitioner - Nurse Practitioner 4880083567 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Clinical Health Care Associates of New Jersey PCGroup PAC ID 0749180198, shared by 7 NPIs, 793 clinicians

Practice addresses (Care Compare)

1865 Route 70 E 260
Penn Cardiology Cherry Hill
Cherry Hill, NJ 08003-2013
Phone (856) 216-0300

51 N 39TH St 4 HVP
Penn Cardiology Penn Presbyterian 4TH Floor
Philadelphia, PA 19104-2640
Phone (215) 662-9189

7133 Roosevelt Blvd
Philadelphia, PA 19149-1431
Phone (215) 333-5604

906 Bethlehem Pike
Erdenheim, PA 19038-7731
Phone (215) 248-1350

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
95017307CAMDAcute Care Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Clinical Health Care Associates of New Jersey PC CurrentSince Aug 21, 2025 Accepting new patients
Clinical Health Care Associates of New Jersey, PC Current Accepting new patients
Clinical Health Care Associates of New Jersey, P.C. CurrentSince Mar 18, 2024 Accepting new patients

Locations

211 S Main St
Ste 205
Cape May Court House, NJ 08210
Phone (609) 463-0800

1865 Route 70 E
Ste 260
Cherry Hill, NJ 08003
Phone (215) 662-9595

7133 Roosevelt Blvd
Philadelphia, PA 19149
Phone (215) 333-3311

Interoperability endpoints

  • Direct secure messaging: ktait951218@direct.uclahealth.org

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1632441600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1739404800000",
    "number": "1629749056",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5767 W CENTURY BLVD STE 400",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900455631"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "51 N 39TH ST",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191042640",
            "telephone_number": "215-662-9000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TAIT",
        "first_name": "KRISTEN",
        "middle_name": "MARA",
        "name_prefix": "Ms.",
        "credential": "AGACNP-BC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-09-24",
        "last_updated": "2025-02-13",
        "certification_date": "2025-02-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2100X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Acute Care",
            "state": "CA",
            "license": "95017307",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Philadelphia, PA

Sources for this page

Verify at the official NPI Registry.