Healthcare Provider Details

I. General information

NPI: 1124692462
Provider Name (Legal Business Name): KRISTEL PICKFORD FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/19/2021
Last Update Date: 09/29/2025
Certification Date: 09/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3959 BROADWAY
NEW YORK NY
10032-1559
US

IV. Provider business mailing address

17 ALLEN LN
SLOATSBURG NY
10974-1723
US

V. Phone/Fax

Practice location:
  • Phone: 845-826-2464
  • Fax:
Mailing address:
  • Phone: 845-826-2464
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WX0003X
TaxonomyInpatient Obstetric Registered Nurse
License Number641036
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number348640
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: