Provider Demographics
NPI:1164447926
Name:KEARNEY, LYNDA L (RPA-C)
Entity Type:Individual
Prefix:MS
First Name:LYNDA
Middle Name:L
Last Name:KEARNEY
Suffix:
Gender:F
Credentials:RPA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 N PINE ST
Mailing Address - Street 2:
Mailing Address - City:GLOVERSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:12078-5919
Mailing Address - Country:US
Mailing Address - Phone:518-762-2020
Mailing Address - Fax:518-736-1200
Practice Address - Street 1:110 N PINE ST
Practice Address - Street 2:
Practice Address - City:GLOVERSVILLE
Practice Address - State:NY
Practice Address - Zip Code:12078-5919
Practice Address - Country:US
Practice Address - Phone:518-762-2020
Practice Address - Fax:518-736-1200
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2016-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011288207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02822815Medicaid
NY02822815Medicaid