Provider Demographics
NPI:1891492948
Name:KETTER-FRANKLIN, KRYSTAL STARR (RN)
Entity Type:Individual
Prefix:
First Name:KRYSTAL
Middle Name:STARR
Last Name:KETTER-FRANKLIN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:KRYSTAL
Other - Middle Name:STAR
Other - Last Name:KETTER-FRANKLIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RN
Mailing Address - Street 1:255 DELAWARE AVE
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14202-2016
Mailing Address - Country:US
Mailing Address - Phone:716-842-0440
Mailing Address - Fax:
Practice Address - Street 1:255 DELAWARE AVE FL 4
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14202-2016
Practice Address - Country:US
Practice Address - Phone:716-842-0440
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-09
Last Update Date:2023-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY62035701163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse