Healthcare Provider Details

I. General information

NPI: 1295008654
Provider Name (Legal Business Name): KRISTIN ANN BERNTSEN NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KRISTIN ANN KENNY NP

II. Dates (important events)

Enumeration Date: 02/15/2012
Last Update Date: 01/30/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1050 CLOVE ROAD
STATEN ISLAND NY
10301-3627
US

IV. Provider business mailing address

2791 RICHMOND AVE. SUITE 201
STATEN ISLAND NY
10314-5859
US

V. Phone/Fax

Practice location:
  • Phone: 718-816-6440
  • Fax: 718-816-3642
Mailing address:
  • Phone: 718-816-6440
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number337143
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: