Provider Demographics
NPI:1497285944
Name:DESTITO, KAYLEE ANNE (FNP)
Entity Type:Individual
Prefix:
First Name:KAYLEE
Middle Name:ANNE
Last Name:DESTITO
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 1:3 PARKSIDE CT
Mailing Address - Street 2:
Mailing Address - City:UTICA
Mailing Address - State:NY
Mailing Address - Zip Code:13501-5643
Mailing Address - Country:US
Mailing Address - Phone:315-724-6787
Mailing Address - Fax:315-735-6624
Practice Address - Street 1:3 PARKSIDE CT
Practice Address - Street 2:
Practice Address - City:UTICA
Practice Address - State:NY
Practice Address - Zip Code:13501-5643
Practice Address - Country:US
Practice Address - Phone:315-724-6787
Practice Address - Fax:315-735-6624
Is Sole Proprietor?:No
Enumeration Date:2017-06-18
Last Update Date:2017-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF341772-1363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily