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General NPI Number Information
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NPI Number | 1619352515
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Entity Type | Individual
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Provider Name | KRISTIE LEIGH KLOSTERMAN NURSE PRACTITIONER
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Gender | Female
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Dates
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Enumeration Date | 07/21/2015
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Last Update Date | 12/03/2024
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Provider Practice Location Address
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Address Line | 524 MONTAUK HWY STE 101
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City | AMAGANSETT
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State | NY
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Zip | 11930-2110
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Country | US
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Telephone | 631-557-3043
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Fax | 631-557-3044
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Provider Business Mailing Address
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Address Line | 5 SQUIRETOWN RD
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City | HAMPTON BAYS
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State | NY
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Zip | 11946-2011
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Country | US
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Telephone | 631-728-5300
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Fax | 631-728-5360
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 702568
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 348178
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License Number State | NY
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