Provider Demographics
NPI:1104492917
Name:FORD, KRYSTAL (NP)
Entity type:Individual
Prefix:
First Name:KRYSTAL
Middle Name:
Last Name:FORD
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:100 KINGS HWY S
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14617-5504
Mailing Address - Country:US
Mailing Address - Phone:585-232-2980
Mailing Address - Fax:585-232-6552
Practice Address - Street 1:995 SENATOR KEATING BLVD STE 330
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14618-2779
Practice Address - Country:US
Practice Address - Phone:585-232-2980
Practice Address - Fax:585-232-6552
Is Sole Proprietor?:No
Enumeration Date:2021-06-02
Last Update Date:2022-09-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY347805363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily