Provider Demographics
NPI:1225399264
Name:PLUMMER, KRYSTAL (PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:KRYSTAL
Middle Name:
Last Name:PLUMMER
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1301 DEER PARK AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH BABYLON
Mailing Address - State:NY
Mailing Address - Zip Code:11703-2728
Mailing Address - Country:US
Mailing Address - Phone:631-358-0848
Mailing Address - Fax:516-715-3782
Practice Address - Street 1:1301 DEER PARK AVE
Practice Address - Street 2:
Practice Address - City:NORTH BABYLON
Practice Address - State:NY
Practice Address - Zip Code:11703-2728
Practice Address - Country:US
Practice Address - Phone:631-358-0848
Practice Address - Fax:631-669-8532
Is Sole Proprietor?:No
Enumeration Date:2012-06-06
Last Update Date:2022-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY630216163W00000X
NY402475363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse