Provider Demographics
NPI:1225656648
Name:KILBORNE, CASEY LYNN (FNP-C)
Entity Type:Individual
Prefix:MRS
First Name:CASEY
Middle Name:LYNN
Last Name:KILBORNE
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1450 CHAMPLIN AVE
Mailing Address - Street 2:
Mailing Address - City:UTICA
Mailing Address - State:NY
Mailing Address - Zip Code:13502-3662
Mailing Address - Country:US
Mailing Address - Phone:315-624-9000
Mailing Address - Fax:
Practice Address - Street 1:1450 CHAMPLIN AVE
Practice Address - Street 2:
Practice Address - City:UTICA
Practice Address - State:NY
Practice Address - Zip Code:13502-3662
Practice Address - Country:US
Practice Address - Phone:315-624-9000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-13
Last Update Date:2020-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF346110-01363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care