Provider Demographics
NPI:1437318755
Name:ABDUL, KEMI STELLA (PSYCHIATRIC NP)
Entity Type:Individual
Prefix:
First Name:KEMI
Middle Name:STELLA
Last Name:ABDUL
Suffix:
Gender:F
Credentials:PSYCHIATRIC NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 PAERDEGAT 14TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11236-4114
Mailing Address - Country:US
Mailing Address - Phone:919-413-1355
Mailing Address - Fax:
Practice Address - Street 1:9 PAERDEGAT 14TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11236-4114
Practice Address - Country:US
Practice Address - Phone:919-413-1355
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-02
Last Update Date:2023-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
172V00000X
NY390200000X
NY403598363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No172V00000XOther Service ProvidersCommunity Health Worker
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program