Provider Demographics
NPI:1235221458
Name:FELICE, KARYN (NP)
Entity Type:Individual
Prefix:
First Name:KARYN
Middle Name:
Last Name:FELICE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:170 WEST AVE
Mailing Address - Street 2:
Mailing Address - City:BROCKPORT
Mailing Address - State:NY
Mailing Address - Zip Code:14420-1227
Mailing Address - Country:US
Mailing Address - Phone:585-395-6052
Mailing Address - Fax:
Practice Address - Street 1:170 WEST AVE
Practice Address - Street 2:
Practice Address - City:BROCKPORT
Practice Address - State:NY
Practice Address - Zip Code:14420-1227
Practice Address - Country:US
Practice Address - Phone:585-395-6052
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2017-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY340486363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02507573Medicaid
NY02507573Medicaid
NYJ400362397-GRP70008AMedicare PIN