Provider Demographics
NPI:1366959678
Name:O'DONNELL, KRISTA M (FNP-C)
Entity type:Individual
Prefix:
First Name:KRISTA
Middle Name:M
Last Name:O'DONNELL
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:40 BAYLOR DR
Mailing Address - Street 2:
Mailing Address - City:SMITHTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:11787-2002
Mailing Address - Country:US
Mailing Address - Phone:631-786-4065
Mailing Address - Fax:
Practice Address - Street 1:NEW YORK SPINE AND BRAIN SURGERY DEPT OF NEUROSURGERY
Practice Address - Street 2:HSC T12 RM 080
Practice Address - City:STONY BROOK
Practice Address - State:NY
Practice Address - Zip Code:11794-8122
Practice Address - Country:US
Practice Address - Phone:631-444-1116
Practice Address - Fax:631-444-1535
Is Sole Proprietor?:No
Enumeration Date:2018-01-08
Last Update Date:2018-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY613325163WC0200X
NY342183363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine