Provider Demographics
NPI:1619352515
Name:KLOSTERMAN, KRISTIE LEIGH (NURSE PRACTITIONER)
Entity type:Individual
Prefix:
First Name:KRISTIE
Middle Name:LEIGH
Last Name:KLOSTERMAN
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 SQUIRETOWN RD
Mailing Address - Street 2:
Mailing Address - City:HAMPTON BAYS
Mailing Address - State:NY
Mailing Address - Zip Code:11946-2011
Mailing Address - Country:US
Mailing Address - Phone:631-728-5300
Mailing Address - Fax:631-728-5360
Practice Address - Street 1:524 MONTAUK HWY STE 101
Practice Address - Street 2:
Practice Address - City:AMAGANSETT
Practice Address - State:NY
Practice Address - Zip Code:11930-2110
Practice Address - Country:US
Practice Address - Phone:631-557-3043
Practice Address - Fax:631-557-3044
Is Sole Proprietor?:No
Enumeration Date:2015-07-21
Last Update Date:2024-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY702568163W00000X
NY348178363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse