Provider Demographics
NPI:1619352515
Name:CONRAD, KRISTIE LEIGH (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:
First Name:KRISTIE
Middle Name:LEIGH
Last Name:CONRAD
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1025
Mailing Address - Street 2:
Mailing Address - City:HAMPTON BAYS
Mailing Address - State:NY
Mailing Address - Zip Code:11946-0401
Mailing Address - Country:US
Mailing Address - Phone:631-728-4700
Mailing Address - Fax:
Practice Address - Street 1:145 W MONTAUK HWY
Practice Address - Street 2:
Practice Address - City:HAMPTON BAYS
Practice Address - State:NY
Practice Address - Zip Code:11946-4012
Practice Address - Country:US
Practice Address - Phone:631-728-4700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-21
Last Update Date:2021-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY702568163W00000X
NY348178363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse