Provider Demographics
NPI:1275564726
Name:REITTER, KATHLEEN (CFNP)
Entity Type:Individual
Prefix:MRS
First Name:KATHLEEN
Middle Name:
Last Name:REITTER
Suffix:
Gender:F
Credentials:CFNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:159 BARNEGAT RD
Mailing Address - Street 2:
Mailing Address - City:POUGHKEEPSIE
Mailing Address - State:NY
Mailing Address - Zip Code:12601-5401
Mailing Address - Country:US
Mailing Address - Phone:845-226-4590
Mailing Address - Fax:
Practice Address - Street 1:1 WEBSTER AVNUE
Practice Address - Street 2:SUITE 302
Practice Address - City:POUGHKEEPSIE
Practice Address - State:NY
Practice Address - Zip Code:12601
Practice Address - Country:US
Practice Address - Phone:845-483-5852
Practice Address - Fax:845-483-5413
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2017-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF330594363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02251247Medicaid
NY323485OtherMVP
NYS74848Medicare UPIN
NY02251247Medicaid