Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | APRN002646 | NY |
NPI | 1003100538 |
---|---|
Provider Name | Samantha Kilkenny |
First Address | Brooklyn, NY 11216-4301 |
Second Address | Brooklyn, NY 11201 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/06/2011 |
Last Update Date | 23/05/2018 |