Healthcare Provider Details

I. General information

NPI: 1336706175
Provider Name (Legal Business Name): KRISTA CLERGE WHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/28/2019
Last Update Date: 09/29/2025
Certification Date: 09/29/2025
Deactivation Date: 06/21/2019
Reactivation Date: 08/11/2025

III. Provider practice location address

18901 NORTHERN BLVD
FLUSHING NY
11358-2824
US

IV. Provider business mailing address

166 FAIRLAWN AVE
WEST HEMPSTEAD NY
11552-2106
US

V. Phone/Fax

Practice location:
  • Phone: 917-410-6905
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number765465
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberF421809-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: