Provider Demographics
NPI:1477974939
Name:PRASAD, KRYSTIN (APN)
Entity type:Individual
Prefix:
First Name:KRYSTIN
Middle Name:
Last Name:PRASAD
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:664 COMMONS WAY BLDG I
Mailing Address - Street 2:
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08755-6431
Mailing Address - Country:US
Mailing Address - Phone:848-210-7151
Mailing Address - Fax:848-238-7424
Practice Address - Street 1:664 COMMONS WAY BLDG I
Practice Address - Street 2:
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08755-6431
Practice Address - Country:US
Practice Address - Phone:848-210-7151
Practice Address - Fax:848-238-7424
Is Sole Proprietor?:No
Enumeration Date:2013-12-30
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00461700363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily