Provider Demographics
NPI:1275527376
Name:CARNES, CELESTE I (NP)
Entity Type:Individual
Prefix:
First Name:CELESTE
Middle Name:I
Last Name:CARNES
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 1:61 DELANO ST
Mailing Address - Street 2:
Mailing Address - City:PULASKI
Mailing Address - State:NY
Mailing Address - Zip Code:13142-1400
Mailing Address - Country:US
Mailing Address - Phone:315-298-6569
Mailing Address - Fax:315-298-7488
Practice Address - Street 1:5856 SCENIC AVE
Practice Address - Street 2:
Practice Address - City:MEXICO
Practice Address - State:NY
Practice Address - Zip Code:13114-3012
Practice Address - Country:US
Practice Address - Phone:315-963-4133
Practice Address - Fax:315-963-4960
Is Sole Proprietor?:No
Enumeration Date:2005-09-02
Last Update Date:2023-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF331423363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00307662Medicaid
NY00331423Medicaid
NY53965LMedicare PIN
NYS25671Medicare UPIN