Provider Demographics
NPI:1225316227
Name:CLEVER, KRISTA (DNP, APN)
Entity Type:Individual
Prefix:
First Name:KRISTA
Middle Name:
Last Name:CLEVER
Suffix:
Gender:F
Credentials:DNP, APN
Other - Prefix:
Other - First Name:KRISTA
Other - Middle Name:
Other - Last Name:GULCZYNSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4535 SOUTHWESTERN BLVD STE 704
Mailing Address - Street 2:
Mailing Address - City:HAMBURG
Mailing Address - State:NY
Mailing Address - Zip Code:14075-1870
Mailing Address - Country:US
Mailing Address - Phone:716-689-3333
Mailing Address - Fax:716-689-9695
Practice Address - Street 1:4535 SOUTHWESTERN BLVD STE 704
Practice Address - Street 2:
Practice Address - City:HAMBURG
Practice Address - State:NY
Practice Address - Zip Code:14075-1870
Practice Address - Country:US
Practice Address - Phone:716-689-3333
Practice Address - Fax:716-689-9695
Is Sole Proprietor?:No
Enumeration Date:2011-07-26
Last Update Date:2019-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY639149163WP0808X
IN71005615A364SP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201315330Medicaid
IN111810024Medicare PIN