Active NPI
Krystal Richards
- Adult Health Nurse Practitioner
- Rosedale, NY
National Provider Identifier
1053968966
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Adult Health Nurse Practitioner
- License
- F309212-01
- Practice address
- 14833 Weller LN
Rosedale, NY 11422-2811 - Phone
- (917) 349-1358
- NPI assigned
- Aug 25, 2019
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Adult Health Nurse Practitioner | 363LA2200X | F309212-01 | NY | Primary |
Addresses
Primary practice location
14833 Weller LN
Rosedale, NY 11422-2811
Mailing address
14833 Weller LN
Rosedale, NY 11422-2811
Phone (917) 349-1358
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| F309212-01 | NY | MD | Adult Health Nurse Practitioner |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1566691200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1566691200000",
"number": "1053968966",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "14833 WELLER LN",
"city": "ROSEDALE",
"state": "NY",
"postal_code": "114222811",
"telephone_number": "917-349-1358"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "14833 WELLER LN",
"city": "ROSEDALE",
"state": "NY",
"postal_code": "114222811",
"telephone_number": "917-349-1358"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RICHARDS",
"first_name": "KRYSTAL",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2019-08-25",
"last_updated": "2019-08-25",
"status": "A"
},
"taxonomies": [
{
"code": "363LA2200X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Adult Health",
"state": "NY",
"license": "F309212-01",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Rosedale, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 25, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.