Provider Demographics
NPI:1689456204
Name:BAEZ, KATY (FNP)
Entity Type:Individual
Prefix:MRS
First Name:KATY
Middle Name:
Last Name:BAEZ
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:KATY
Other - Middle Name:
Other - Last Name:BAEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:25 S MAIN ST STE D
Mailing Address - Street 2:
Mailing Address - City:SPRING VALLEY
Mailing Address - State:NY
Mailing Address - Zip Code:10977-4917
Mailing Address - Country:US
Mailing Address - Phone:845-499-5696
Mailing Address - Fax:845-517-2001
Practice Address - Street 1:25 S MAIN ST STE D
Practice Address - Street 2:
Practice Address - City:SPRING VALLEY
Practice Address - State:NY
Practice Address - Zip Code:10977-4917
Practice Address - Country:US
Practice Address - Phone:845-499-5496
Practice Address - Fax:845-499-5496
Is Sole Proprietor?:No
Enumeration Date:2023-10-18
Last Update Date:2023-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY352999363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily