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General NPI Number Information
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NPI Number | 1588246466
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Entity Type | Organization
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Legal Business Name | KK NP IN ADULT HEALTH LLP
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Dates
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Enumeration Date | 04/21/2021
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Last Update Date | 04/18/2023
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Provider Practice Location Address
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Address Line | 635 BELLE TERRE RD STE 103
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City | PORT JEFFERSON
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State | NY
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Zip | 11777-1987
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Country | US
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Telephone | 631-675-9000
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Fax | 631-675-9002
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Provider Business Mailing Address
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Address Line | 635 BELLE TERRE RD STE 103
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City | PORT JEFFERSON
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State | NY
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Zip | 11777-1987
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Country | US
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Telephone | 631-675-9000
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Fax | 631-675-9002
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Authorized Official
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Title or Position | PROVIDER
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Name | KRIS JOHNSTON
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Credential | NP
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Telephone | 631-675-9000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State |
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