Healthcare Provider Details

I. General information

NPI: 1588040497
Provider Name (Legal Business Name): KHRYSTYNA MOKRIY FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/03/2015
Last Update Date: 03/25/2025
Certification Date: 03/25/2025
Deactivation Date: 06/20/2023
Reactivation Date: 03/10/2025

III. Provider practice location address

2229 ROUTE 9
MECHANICVILLE NY
12118-3021
US

IV. Provider business mailing address

2229 ROUTE 9
MECHANICVILLE NY
12118-3021
US

V. Phone/Fax

Practice location:
  • Phone: 440-390-9793
  • Fax:
Mailing address:
  • Phone: 440-390-9793
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF355819-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: