Provider Demographics
NPI:1326523176
Name:EMERSON, KATHLEEN MARY (FNP)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:MARY
Last Name:EMERSON
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 1:375 BAY RD STE 101
Mailing Address - Street 2:
Mailing Address - City:QUEENSBURY
Mailing Address - State:NY
Mailing Address - Zip Code:12804-3010
Mailing Address - Country:US
Mailing Address - Phone:518-932-7234
Mailing Address - Fax:518-480-3062
Practice Address - Street 1:375 BAY RD STE 101
Practice Address - Street 2:
Practice Address - City:QUEENSBURY
Practice Address - State:NY
Practice Address - Zip Code:12804-3010
Practice Address - Country:US
Practice Address - Phone:518-932-7234
Practice Address - Fax:518-480-3062
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-27
Last Update Date:2024-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY343121363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty