Provider Demographics
NPI:1255678710
Name:CHRISTIE, KAYLA (LPN)
Entity type:Individual
Prefix:
First Name:KAYLA
Middle Name:
Last Name:CHRISTIE
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25712 149TH AVE
Mailing Address - Street 2:
Mailing Address - City:ROSEDALE
Mailing Address - State:NY
Mailing Address - Zip Code:11422-3021
Mailing Address - Country:US
Mailing Address - Phone:347-400-2504
Mailing Address - Fax:
Practice Address - Street 1:1 CROSS ISLAND PLZ STE 203A
Practice Address - Street 2:
Practice Address - City:ROSEDALE
Practice Address - State:NY
Practice Address - Zip Code:11422-1465
Practice Address - Country:US
Practice Address - Phone:718-978-4999
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-01-03
Last Update Date:2013-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY313270164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse