Provider Demographics
NPI:1043908429
Name:KRISTEN BERNOCKIE NP IN FAMILY HEALTH PLLC
Entity Type:Organization
Organization Name:KRISTEN BERNOCKIE NP IN FAMILY HEALTH PLLC
Other - Org Name:EUTIERRIA WELLNESS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KRISTEN
Authorized Official - Middle Name:
Authorized Official - Last Name:BERNOCKIE
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:518-653-9699
Mailing Address - Street 1:35 INDUSTRIAL TRACT ANX
Mailing Address - Street 2:
Mailing Address - City:HUDSON
Mailing Address - State:NY
Mailing Address - Zip Code:12534-1505
Mailing Address - Country:US
Mailing Address - Phone:518-291-8844
Mailing Address - Fax:
Practice Address - Street 1:35 INDUSTRIAL TRACT ANX
Practice Address - Street 2:
Practice Address - City:HUDSON
Practice Address - State:NY
Practice Address - Zip Code:12534-1505
Practice Address - Country:US
Practice Address - Phone:518-291-8844
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-25
Last Update Date:2024-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY07742996Medicaid