Provider Demographics
NPI:1861085516
Name:WELKLEY, KRISTI MARIE (RN BSN)
Entity type:Individual
Prefix:
First Name:KRISTI
Middle Name:MARIE
Last Name:WELKLEY
Suffix:
Gender:F
Credentials:RN BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11400 SALTER COLVIN RD
Mailing Address - Street 2:
Mailing Address - City:WOLCOTT
Mailing Address - State:NY
Mailing Address - Zip Code:14590-9331
Mailing Address - Country:US
Mailing Address - Phone:315-263-7363
Mailing Address - Fax:
Practice Address - Street 1:7231 JACKSON HILL RD
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NY
Practice Address - Zip Code:14513-9111
Practice Address - Country:US
Practice Address - Phone:315-945-3545
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-13
Last Update Date:2021-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY777691163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163W00000XNursing Service ProvidersRegistered NurseGroup - Single Specialty