Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LC1500X | Nurse Practitioner - Community Health | F320027 | NY |
Y | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | F401064 | NY |
NPI | 1568405009 |
---|---|
Provider Name | Kathleen Mary Kennedy |
First Address | Endicott, NY 13760-6435 |
Second Address | Binghamton, NY 13901-2756 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/06/2006 |
Last Update Date | 14/07/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0320F320027 | (05) | NY |