Provider Demographics
NPI:1073227856
Name:SOUTHERN ADIRONDACK FAMILY HEALTH-NP, PLLC
Entity Type:Organization
Organization Name:SOUTHERN ADIRONDACK FAMILY HEALTH-NP, PLLC
Other - Org Name:SOUTHERN ADIRONDACK FAMILY HEALTH-NP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:FNP
Authorized Official - Prefix:
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:M
Authorized Official - Last Name:EMERSON
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:518-932-7234
Mailing Address - Street 1:375 BAY RD STE 101
Mailing Address - Street 2:
Mailing Address - City:QUEENSBURY
Mailing Address - State:NY
Mailing Address - Zip Code:12804-3012
Mailing Address - Country:US
Mailing Address - Phone:518-932-7234
Mailing Address - Fax:
Practice Address - Street 1:375 BAY RD STE 101
Practice Address - Street 2:
Practice Address - City:QUEENSBURY
Practice Address - State:NY
Practice Address - Zip Code:12804-3012
Practice Address - Country:US
Practice Address - Phone:518-932-7234
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-06
Last Update Date:2023-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care