Provider Demographics
NPI:1366676066
Name:HEYWOOD-GREGORY, KAMILAH N (FNP)
Entity Type:Individual
Prefix:MISS
First Name:KAMILAH
Middle Name:N
Last Name:HEYWOOD-GREGORY
Suffix:
Gender:F
Credentials:FNP
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Mailing Address - Street 1:22 SAW MILL RIVER RD
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:HAWTHORNE
Mailing Address - State:NY
Mailing Address - Zip Code:10532-1533
Mailing Address - Country:US
Mailing Address - Phone:914-493-8558
Mailing Address - Fax:914-493-1488
Practice Address - Street 1:19 BRADHURST AVE
Practice Address - Street 2:STE 1400
Practice Address - City:HAWTHORNE
Practice Address - State:NY
Practice Address - Zip Code:10532-2140
Practice Address - Country:US
Practice Address - Phone:914-493-8558
Practice Address - Fax:914-493-1488
Is Sole Proprietor?:No
Enumeration Date:2009-05-08
Last Update Date:2013-07-23
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Provider Licenses
StateLicense IDTaxonomies
NYF335845363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03111846Medicaid
NYA400012362Medicare PIN
NYA400012361Medicare PIN