Kristine Mae Faddisstuart

Primary specialty

Peer SpecialistTaxonomy code 175T00000X

License

MPSS-RMODKG Issued in CA

Practice address

590 Toyanza Drive
San Andreas, CA 95249-9713

Phone

(209) 754-6562

NPI assigned

Mar 31, 2026

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

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": "1774915200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1774915200000",
    "number": "1891635520",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1825 LIVE OAK DR",
            "city": "VALLECITO",
            "state": "CA",
            "postal_code": "952519603",
            "telephone_number": "209-256-0249"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "590 TOYANZA DRIVE",
            "city": "SAN ANDREAS",
            "state": "CA",
            "postal_code": "952499713",
            "telephone_number": "209-754-6562"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FADDISSTUART",
        "first_name": "KRISTINE",
        "middle_name": "MAE",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2026-03-31",
        "last_updated": "2026-03-31",
        "certification_date": "2026-03-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "175T00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Peer Specialist",
            "state": "CA",
            "license": "MPSS-RMODKG",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Stephanie Dorsey, LCSW
• Bruce Stephen Dunwell, DDS
• Emergency Medicine Physician Partners of Calaveras County, Inc
• Emergency Medicine Physicians of Calaveras County, Inc.
• Emergency Physicians Medical Group, Inc
• Jose C Favela
• Roberta Fields, CMT
• Luz Karina Flores
• Katie Foley
• Denice Lee Fonceca

• All providers in San Andreas, CA
• Peer Specialist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 31, 2026; 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.