Holly Jennifer Mistark, RN

Primary specialty

Registered NurseTaxonomy code 163W00000X

License

774164 Issued in NY

Practice address

2617 East Ave
Brighton, NY 14610-3149

Phone

(585) 504-4167

NPI assigned

May 25, 2022

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Registered Nurse

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1653436800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1653436800000",
    "number": "1033857404",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "330 E COMMERCIAL ST",
            "city": "EAST ROCHESTER",
            "state": "NY",
            "postal_code": "144451504",
            "telephone_number": "585-430-8664"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2617 EAST AVE",
            "city": "BRIGHTON",
            "state": "NY",
            "postal_code": "146103149",
            "telephone_number": "585-504-4167"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MISTARK",
        "first_name": "HOLLY",
        "middle_name": "JENNIFER",
        "credential": "RN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-05-25",
        "last_updated": "2022-05-25",
        "certification_date": "2022-05-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "NY",
            "license": "774164",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "Rochester",
            "affiliation": "N",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "address_1": "2617 East Ave",
            "city": "Brighton",
            "state": "NY",
            "country_code": "US",
            "postal_code": "146103149",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Kristina Ann Dillenbeck, OTR-L
• Sarah Ann Dirks, NP
• Lydell Hill
• Kaitlin Larissa Kulzer, NP
• Kaylee Lewis, CRNP
• Shaquana Latifah Nevels, LPN
• Cassandra Peete, PA-C
• Christopher Adolphus Reader, RN
• Melinda Sue Westbrook, NP
• Wound Pros New York

• Registered Nurse in Brighton, NY
• Providers in Brighton, NY by specialty
• Registered Nurse in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 25, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.