Kristen Vandyke
Individual provider Active NPI Licensed Practical Nurse · Waverly, NY
NPI 1346056728 · NPPES record last updated Dec 10, 2024
Key facts
- NPI
- 1346056728
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Licensed Practical Nurse 164W00000X
- License
- 328099 (NY)
- Practice address
- 31 Circle Dr
Waverly, NY 14892-9744 - Phone
- (570) 423-4629
- NPI assigned
- Dec 10, 2024
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 328099 | NY | MD | Licensed Practical Nurse |
| PN304019 | PA | MD | Licensed Practical Nurse |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Licensed Practical Nurse | 164W00000X | PN304019 | PA | |
| Licensed Practical Nurse | 164W00000X | 328099 | NY | Yes |
Addresses
Primary practice location
31 Circle Dr
Waverly, NY 14892-9744
Mailing address
31 Circle Dr
Waverly, NY 14892-9744
Other providers in Waverly, NY
- Tioga Nursing Facility
- Tioga Nursing Home
- Tots' Learning Center
- Melissa Traub
- Kelsey B Twedt
- Jennifer Wagner
- Molly Sue Wallace-Welch
- Patricia Louise Ward
- Waverly Central School District
- Waverly Medical Associates LLC
All providers in Waverly, NY · Licensed Practical Nurse in New York
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 10, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.