Provider Demographics
NPI:1275133175
Name:LIEKFET, KRISTY (APN-C)
Entity Type:Individual
Prefix:
First Name:KRISTY
Middle Name:
Last Name:LIEKFET
Suffix:
Gender:F
Credentials:APN-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:ANGELIC HEALTH
Mailing Address - Street 2:8025 BLACK HORSE PIKE, SUITE 501
Mailing Address - City:WEST ATLANTIC CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:08232
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:ATLANTICARE APG PALLIATIVE CARE
Practice Address - Street 2:1925 PACIFIC AVE. 1ST FLR
Practice Address - City:ATLANTIC CITY
Practice Address - State:NJ
Practice Address - Zip Code:08401
Practice Address - Country:US
Practice Address - Phone:609-345-4000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-29
Last Update Date:2020-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ01068100363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health