Provider Demographics
NPI:1558700211
Name:MCFADDEN, KRISTY LYNN (RN)
Entity Type:Individual
Prefix:
First Name:KRISTY
Middle Name:LYNN
Last Name:MCFADDEN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3B LONGVIEW RD
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10304-1709
Mailing Address - Country:US
Mailing Address - Phone:347-576-9824
Mailing Address - Fax:
Practice Address - Street 1:3B LONGVIEW RD
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10304-1709
Practice Address - Country:US
Practice Address - Phone:347-576-9824
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-17
Last Update Date:2013-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY668071163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse