Provider Demographics
NPI:1114010428
Name:KEARNEY, CAROLYN H (ANP)
Entity Type:Individual
Prefix:
First Name:CAROLYN
Middle Name:H
Last Name:KEARNEY
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8277 BARKSDALE LN
Mailing Address - Street 2:
Mailing Address - City:MANLIUS
Mailing Address - State:NY
Mailing Address - Zip Code:13104
Mailing Address - Country:US
Mailing Address - Phone:315-682-7069
Mailing Address - Fax:315-464-5168
Practice Address - Street 1:750 E ADAMS ST
Practice Address - Street 2:UPSTATE MEDICAL UNIVERS @ SYRACUSE COLLEGE OF NURSING
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13210
Practice Address - Country:US
Practice Address - Phone:315-464-3911
Practice Address - Fax:315-464-5168
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY3397941163W00000X
NYF3020201363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered163W00000XNursing Service ProvidersRegistered Nurse
Not Answered363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner