Provider Demographics
NPI:1659757441
Name:BROWN, KRYSTA L (C-PNP)
Entity Type:Individual
Prefix:
First Name:KRYSTA
Middle Name:L
Last Name:BROWN
Suffix:
Gender:F
Credentials:C-PNP
Other - Prefix:
Other - First Name:KRYSTA
Other - Middle Name:L
Other - Last Name:BROWN-KLOCHANEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9 CAREY RD
Mailing Address - Street 2:
Mailing Address - City:QUEENSBURY
Mailing Address - State:NY
Mailing Address - Zip Code:12804-7880
Mailing Address - Country:US
Mailing Address - Phone:518-761-0300
Mailing Address - Fax:518-824-2388
Practice Address - Street 1:28 S WESTERN AVE
Practice Address - Street 2:
Practice Address - City:QUEENSBURY
Practice Address - State:NY
Practice Address - Zip Code:12804-3323
Practice Address - Country:US
Practice Address - Phone:518-798-6400
Practice Address - Fax:518-798-4105
Is Sole Proprietor?:No
Enumeration Date:2015-08-04
Last Update Date:2022-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF382563363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY04644693Medicaid