1114010428 NPI number — CAROLYN H KEARNEY ANP

Table of content: CAROLYN H KEARNEY ANP (NPI 1114010428)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114010428 NPI number — CAROLYN H KEARNEY ANP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KEARNEY
Provider First Name:
CAROLYN
Provider Middle Name:
H
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
ANP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1114010428
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8277 BARKSDALE LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MANLIUS
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
13104
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
315-682-7069
Provider Business Mailing Address Fax Number:
315-464-5168

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
750 E ADAMS ST
Provider Second Line Business Practice Location Address:
UPSTATE MEDICAL UNIVERS @ SYRACUSE COLLEGE OF NURSING
Provider Business Practice Location Address City Name:
SYRACUSE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
13210
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
315-464-3911
Provider Business Practice Location Address Fax Number:
315-464-5168
Provider Enumeration Date:
10/02/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 163W00000X , with the licence number:  3397941 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 363L00000X , with the licence number: F3020201 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

Other Provider's Identifiers (legacy, non-NPI)