Provider Demographics
NPI:1598867723
Name:KIME, CARRIE
Entity Type:Individual
Prefix:
First Name:CARRIE
Middle Name:
Last Name:KIME
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:789 PRE EMPTION RD
Mailing Address - Street 2:SUITE 600
Mailing Address - City:GENEVA
Mailing Address - State:NY
Mailing Address - Zip Code:14456-2069
Mailing Address - Country:US
Mailing Address - Phone:315-719-0060
Mailing Address - Fax:315-719-0230
Practice Address - Street 1:789 PRE EMPTION RD
Practice Address - Street 2:SUITE 600
Practice Address - City:GENEVA
Practice Address - State:NY
Practice Address - Zip Code:14456-2069
Practice Address - Country:US
Practice Address - Phone:315-230-5646
Practice Address - Fax:315-230-5645
Is Sole Proprietor?:No
Enumeration Date:2006-09-01
Last Update Date:2010-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY335035363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02864368Medicaid
NYRB2301Medicare PIN
NYRB2299Medicare PIN