Provider Demographics
NPI:1952020406
Name:WAY, KRISTINA (AGPCNP, PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:KRISTINA
Middle Name:
Last Name:WAY
Suffix:
Gender:F
Credentials:AGPCNP, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:614 PENNSYLVANIA AVE APT 2
Mailing Address - Street 2:
Mailing Address - City:ELIZABETH
Mailing Address - State:NJ
Mailing Address - Zip Code:07201-1265
Mailing Address - Country:US
Mailing Address - Phone:973-592-5750
Mailing Address - Fax:
Practice Address - Street 1:614 PENNSYLVANIA AVE APT 2
Practice Address - Street 2:
Practice Address - City:ELIZABETH
Practice Address - State:NJ
Practice Address - Zip Code:07201-1265
Practice Address - Country:US
Practice Address - Phone:973-592-5750
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-26
Last Update Date:2023-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY309685363LA2200X
NY404316363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health