Provider Demographics
NPI:1043452253
Name:HETHERINGTON, KATHY (MLP-NURSE PRACTIONER)
Entity Type:Individual
Prefix:
First Name:KATHY
Middle Name:
Last Name:HETHERINGTON
Suffix:
Gender:F
Credentials:MLP-NURSE PRACTIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2500 MARCUS AVE
Mailing Address - Street 2:SUITE 105
Mailing Address - City:NEW HYDE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11042-1097
Mailing Address - Country:US
Mailing Address - Phone:516-358-1200
Mailing Address - Fax:516-358-2340
Practice Address - Street 1:2500 MARCUS AVE
Practice Address - Street 2:SUITE 105
Practice Address - City:NEW HYDE PARK
Practice Address - State:NY
Practice Address - Zip Code:11042-1097
Practice Address - Country:US
Practice Address - Phone:516-358-1200
Practice Address - Fax:516-358-2340
Is Sole Proprietor?:No
Enumeration Date:2009-04-02
Last Update Date:2009-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY335654363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily