Healthcare Provider Details

I. General information

NPI: 1831014844
Provider Name (Legal Business Name): CALYSTRA K N JOHN
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/11/2026
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6424 18TH AVE
BROOKLYN NY
11204-3729
US

IV. Provider business mailing address

6424 18TH AVE
BROOKLYN NY
11204-3729
US

V. Phone/Fax

Practice location:
  • Phone: 347-369-9962
  • Fax:
Mailing address:
  • Phone: 347-369-9962
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number357217
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: