1962908293 NPI number — KIMBERLY S KELSTONE DNP, CNM

Table of content: MS. LORI HAMILTON PTA (NPI 1346367216)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1962908293 NPI number — KIMBERLY S KELSTONE DNP, CNM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KELSTONE
Provider First Name:
KIMBERLY
Provider Middle Name:
S
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DNP, CNM
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:
1962908293
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/03/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
251 SALINA MEADOWS PKWY
Provider Second Line Business Mailing Address:
STE 100
Provider Business Mailing Address City Name:
SYRACUSE
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
13212-4516
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
315-464-2000
Provider Business Mailing Address Fax Number:
315-464-2010

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
725 IRVING AVE
Provider Second Line Business Practice Location Address:
STE 600
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:
315-464-5162
Provider Business Practice Location Address Fax Number:
315-464-4613
Provider Enumeration Date:
04/04/2018

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: 367A00000X , with the licence number:  001880 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 367A00000X , with the licence number: 002480175 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 001880 . This is a "NY STATE OFFICE OF THE PROFESSIONS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 05247618 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0024180175 . This is a "VIRGINIA BOARD OF NURSING" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".




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