Provider Demographics
NPI:1619902889
Name:CONROY, KIMBERLY MARIE (APRN-BC)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:MARIE
Last Name:CONROY
Suffix:
Gender:F
Credentials:APRN-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2656 W STATE ST
Mailing Address - Street 2:SUITE 502
Mailing Address - City:OLEAN
Mailing Address - State:NY
Mailing Address - Zip Code:14760-1871
Mailing Address - Country:US
Mailing Address - Phone:716-373-2796
Mailing Address - Fax:716-373-8592
Practice Address - Street 1:2656 W STATE ST
Practice Address - Street 2:SUITE 502
Practice Address - City:OLEAN
Practice Address - State:NY
Practice Address - Zip Code:14760-1871
Practice Address - Country:US
Practice Address - Phone:716-373-2796
Practice Address - Fax:716-373-8592
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF400540-1363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY7804304OtherAETNA
NY7480187OtherGHI
NY337111OtherVALUE OPTIONS
NY000560522003OtherBLUE CROSS BLUE SHIELD
NY9190043OtherINDEPENDENT HEALTH
NY7480187OtherGHI
NYCC5527Medicare ID - Type Unspecified