Provider Demographics
NPI:1760997886
Name:SAMSON, KRIUPA (PMHNP, BSN RN)
Entity Type:Individual
Prefix:
First Name:KRIUPA
Middle Name:
Last Name:SAMSON
Suffix:
Gender:F
Credentials:PMHNP, BSN RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1624 E 12TH ST APT 1F
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11229-1094
Mailing Address - Country:US
Mailing Address - Phone:347-323-1446
Mailing Address - Fax:
Practice Address - Street 1:1624 E 12TH ST APT 1F
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11229-1094
Practice Address - Country:US
Practice Address - Phone:347-323-1446
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-12
Last Update Date:2020-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY701235163W00000X
NY403134363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse