Healthcare Provider Details

I. General information

NPI: 1982028858
Provider Name (Legal Business Name): KRISTINE INGRO PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/12/2014
Last Update Date: 12/09/2025
Certification Date: 12/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6722 ERIE RD
DERBY NY
14047-9670
US

IV. Provider business mailing address

6722 ERIE RD
DERBY NY
14047-9670
US

V. Phone/Fax

Practice location:
  • Phone: 716-947-5025
  • Fax: 716-494-7170
Mailing address:
  • Phone: 716-947-5025
  • Fax: 716-494-7170

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number403385
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number633059
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: