Provider Demographics
NPI:1114477783
Name:BYRD, KARLY (PA)
Entity Type:Individual
Prefix:
First Name:KARLY
Middle Name:
Last Name:BYRD
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:KARLY
Other - Middle Name:
Other - Last Name:WOODRICK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:6 WELLNESS WAY STE 201
Mailing Address - Street 2:
Mailing Address - City:LATHAM
Mailing Address - State:NY
Mailing Address - Zip Code:12110-2156
Mailing Address - Country:US
Mailing Address - Phone:518-782-3700
Mailing Address - Fax:518-782-3799
Practice Address - Street 1:6 WELLNESS WAY STE G02
Practice Address - Street 2:
Practice Address - City:LATHAM
Practice Address - State:NY
Practice Address - Zip Code:12110-2135
Practice Address - Country:US
Practice Address - Phone:518-782-3900
Practice Address - Fax:518-782-3844
Is Sole Proprietor?:No
Enumeration Date:2016-10-07
Last Update Date:2024-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY020199363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical