Provider Demographics
NPI:1477233252
Name:KEGLEY, CELESTE (NP)
Entity Type:Individual
Prefix:
First Name:CELESTE
Middle Name:
Last Name:KEGLEY
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 1:2211 GENESEE ST STE 200
Mailing Address - Street 2:
Mailing Address - City:UTICA
Mailing Address - State:NY
Mailing Address - Zip Code:13501-5955
Mailing Address - Country:US
Mailing Address - Phone:315-733-7598
Mailing Address - Fax:
Practice Address - Street 1:2211 GENESEE ST STE 200
Practice Address - Street 2:
Practice Address - City:UTICA
Practice Address - State:NY
Practice Address - Zip Code:13501-5955
Practice Address - Country:US
Practice Address - Phone:315-733-7598
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-18
Last Update Date:2023-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY352326363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily