Provider Demographics
NPI:1508247743
Name:AUSTIN, LYSTRA (NP)
Entity Type:Individual
Prefix:MS
First Name:LYSTRA
Middle Name:
Last Name:AUSTIN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:543 E 21ST ST
Mailing Address - Street 2:APT D1
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11226-6868
Mailing Address - Country:US
Mailing Address - Phone:718-282-5084
Mailing Address - Fax:
Practice Address - Street 1:543 E 21ST ST
Practice Address - Street 2:APT D1
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11226-6868
Practice Address - Country:US
Practice Address - Phone:718-282-5084
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-12
Last Update Date:2015-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF338546-1363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily