Provider Demographics
NPI:1114119161
Name:MCLOUGHLIN, KAMMY (NP)
Entity Type:Individual
Prefix:MS
First Name:KAMMY
Middle Name:
Last Name:MCLOUGHLIN
Suffix:
Gender:F
Credentials:NP
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Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:STONY BROOK UNIVERSITY MEDICAL CENTER
Mailing Address - Street 2:HSC T19 ROOM 090
Mailing Address - City:STONY BROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11794-0001
Mailing Address - Country:US
Mailing Address - Phone:631-444-2044
Mailing Address - Fax:631-444-8824
Practice Address - Street 1:STONY BROOK UNIVERSITY MEDICAL CENTER
Practice Address - Street 2:HSC T19 ROOM 090
Practice Address - City:STONY BROOK
Practice Address - State:NY
Practice Address - Zip Code:11794-0001
Practice Address - Country:US
Practice Address - Phone:631-444-2044
Practice Address - Fax:631-444-8824
Is Sole Proprietor?:No
Enumeration Date:2007-08-14
Last Update Date:2007-08-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NYF381593363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics