Provider Demographics
NPI:1275046161
Name:ENEA, KRISTY LEIGH (RN)
Entity Type:Individual
Prefix:
First Name:KRISTY
Middle Name:LEIGH
Last Name:ENEA
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:605 PALMER ST
Mailing Address - Street 2:
Mailing Address - City:FRANKFORT
Mailing Address - State:NY
Mailing Address - Zip Code:13340-1428
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:605 PALMER ST
Practice Address - Street 2:
Practice Address - City:FRANKFORT
Practice Address - State:NY
Practice Address - Zip Code:13340-1428
Practice Address - Country:US
Practice Address - Phone:315-894-1768
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-14
Last Update Date:2017-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY5551835163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WS0200XNursing Service ProvidersRegistered NurseSchoolGroup - Single Specialty