Provider Demographics
NPI:1053327247
Name:BARONE, KATHLEEN MARIE (FNP)
Entity Type:Individual
Prefix:MS
First Name:KATHLEEN
Middle Name:MARIE
Last Name:BARONE
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:MS
Other - First Name:KATHLEEN
Other - Middle Name:MARIE
Other - Last Name:HARRISON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1150 YOUNGS RD STE 104
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221-8024
Mailing Address - Country:US
Mailing Address - Phone:716-636-7979
Mailing Address - Fax:716-636-7993
Practice Address - Street 1:1150 YOUNGS RD STE 104
Practice Address - Street 2:
Practice Address - City:WILLIAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14221-8024
Practice Address - Country:US
Practice Address - Phone:716-636-7990
Practice Address - Fax:716-636-7990
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF334027-1363LF0000X
NYF-334027-1363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00026761902OtherUNIVERA
NY9512136OtherIHA
NY161000580OtherNOVA
NY000560806002OtherHEALTH NOW
NY02408111Medicaid
NY9512136OtherIHA
NY02408111Medicaid
NY161000580OtherNOVA
NYRA9045Medicare ID - Type Unspecified
NYRB6637Medicare PIN