Provider Demographics
NPI:1225374333
Name:RAIO, KRISTY MARIE (ANP)
Entity Type:Individual
Prefix:
First Name:KRISTY
Middle Name:MARIE
Last Name:RAIO
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35 HICKORY AVE
Mailing Address - Street 2:
Mailing Address - City:FARMINGVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11738-1713
Mailing Address - Country:US
Mailing Address - Phone:631-404-2399
Mailing Address - Fax:
Practice Address - Street 1:1920 DEER PARK AVE STE 104
Practice Address - Street 2:
Practice Address - City:DEER PARK
Practice Address - State:NY
Practice Address - Zip Code:11729-3314
Practice Address - Country:US
Practice Address - Phone:631-392-1680
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-12-17
Last Update Date:2022-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY306166363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health