Kathy Jo Mistretta, LPN

Primary specialty

Licensed Practical NurseTaxonomy code 164W00000X

License

253381-1 Issued in NY

Practice address

6620 East Bethany Leroy Rd
Stafford, NY 14143-9565

Phone

(585) 768-4646

NPI assigned

Mar 11, 2010

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1268265600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1547510400000",
    "number": "1982927430",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4390 YORK RD",
            "city": "LEICESTER",
            "state": "NY",
            "postal_code": "144819706",
            "telephone_number": "585-481-0904"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6620 EAST BETHANY LEROY RD",
            "city": "STAFFORD",
            "state": "NY",
            "postal_code": "141439565",
            "telephone_number": "585-768-4646"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4390 York Rd",
            "address_purpose": "LOCATION",
            "city": "Leicester",
            "state": "NY",
            "postal_code": "144819706",
            "country_code": "US",
            "telephone_number": "585-481-0904",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MISTRETTA",
        "first_name": "KATHY",
        "middle_name": "JO",
        "name_prefix": "Mrs.",
        "credential": "LPN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2010-03-11",
        "last_updated": "2019-01-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "164W00000X",
            "taxonomy_group": "",
            "desc": "Licensed Practical Nurse",
            "state": "NY",
            "license": "253381-1",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Michelle Lynn Feary, LPN
• Stefanie R Roetzer, MS.ED.
• Aubrey Ann Wilday
• Christina M Wille, LMT

• All providers in Stafford, NY
• Licensed Practical Nurse in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 15, 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.

Verify at the official NPI Registry.