Provider Demographics
NPI:1255571451
Name:RAYMOND, KRYSTEN ANNE (RPA-C)
Entity type:Individual
Prefix:MS
First Name:KRYSTEN
Middle Name:ANNE
Last Name:RAYMOND
Suffix:
Gender:F
Credentials:RPA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:207 GLEN COVE AVE
Mailing Address - Street 2:
Mailing Address - City:SEA CLIFF
Mailing Address - State:NY
Mailing Address - Zip Code:11579-1455
Mailing Address - Country:US
Mailing Address - Phone:516-676-1742
Mailing Address - Fax:516-676-9662
Practice Address - Street 1:207 GLEN COVE AVE
Practice Address - Street 2:
Practice Address - City:SEA CLIFF
Practice Address - State:NY
Practice Address - Zip Code:11579-1455
Practice Address - Country:US
Practice Address - Phone:516-676-1742
Practice Address - Fax:516-676-9662
Is Sole Proprietor?:No
Enumeration Date:2009-02-27
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012589363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYMR1785786OtherDEA