Provider Demographics
NPI:1689750697
Name:O'MARA, KATHLEEN L (FNP)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:L
Last Name:O'MARA
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 1:314 TONJES RD
Mailing Address - Street 2:
Mailing Address - City:CALLICOON
Mailing Address - State:NY
Mailing Address - Zip Code:12723-5742
Mailing Address - Country:US
Mailing Address - Phone:845-482-3514
Mailing Address - Fax:845-482-3507
Practice Address - Street 1:43 MAIN ST.
Practice Address - Street 2:
Practice Address - City:LIVINGSTON MANOR
Practice Address - State:NY
Practice Address - Zip Code:12758-0800
Practice Address - Country:US
Practice Address - Phone:845-439-8731
Practice Address - Fax:845-439-8370
Is Sole Proprietor?:No
Enumeration Date:2006-10-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY334094363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily