Provider Demographics
NPI:1194225524
Name:KISSINGER, KATHLEEN (FNP)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:
Last Name:KISSINGER
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2510 RIVERFRONT CTR
Mailing Address - Street 2:
Mailing Address - City:AMSTERDAM
Mailing Address - State:NY
Mailing Address - Zip Code:12010-4614
Mailing Address - Country:US
Mailing Address - Phone:518-627-0469
Mailing Address - Fax:
Practice Address - Street 1:2510 RIVERFRONT CTR
Practice Address - Street 2:
Practice Address - City:AMSTERDAM
Practice Address - State:NY
Practice Address - Zip Code:12010-4614
Practice Address - Country:US
Practice Address - Phone:518-627-0469
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-12
Last Update Date:2020-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY342658363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1396761474Medicaid