Individual
KELLY JOCELYN KREIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RN, LMT
Contact information
Practice address
2500 ROUTE 347, SUITE 8D, STONY BROOK, NY 11790-2555
(516) 381-0276
Mailing address
2500 ROUTE 347, SUITE 8D, STONY BROOK, NY 11790-2555
(516) 381-0276
Taxonomy
Speciality
Code
Description
License number
State
163WM1400X
Nurse Massage Therapist (NMT)
020418-1
NY
163WM1400X
Nurse Massage Therapist (NMT)
Primary
640956-1
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
020418-1
NYS LICENSED MASSAGE THERAPIST
NY
01
—
527755-07
NATIONALLY CERTIFIED FOR THERAPEUTIC MASSAGE AND BODYWORK
—
01
—
6409561
NY REGISTERED PROFESSIONAL NURSE
NY
Enumeration date
03/06/2012
Last updated
03/06/2012
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