Provider Demographics
NPI:1710357959
Name:FEERICK, KAITLYN JEAN (RN)
Entity Type:Individual
Prefix:
First Name:KAITLYN
Middle Name:JEAN
Last Name:FEERICK
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:117 N GREENE AVE
Mailing Address - Street 2:
Mailing Address - City:LINDENHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11757-4156
Mailing Address - Country:US
Mailing Address - Phone:631-835-1358
Mailing Address - Fax:
Practice Address - Street 1:117 N GREENE AVE
Practice Address - Street 2:
Practice Address - City:LINDENHURST
Practice Address - State:NY
Practice Address - Zip Code:11757-4156
Practice Address - Country:US
Practice Address - Phone:631-835-1358
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-30
Last Update Date:2015-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY705859251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health