Provider Demographics
NPI:1710991328
Name:ALCOTT, KAREN (NP)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:
Last Name:ALCOTT
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4870 BROAD RD
Mailing Address - Street 2:SUITE 3Q
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13215-2206
Mailing Address - Country:US
Mailing Address - Phone:315-492-5765
Mailing Address - Fax:315-492-5123
Practice Address - Street 1:4870 BROAD RD
Practice Address - Street 2:SUITE 3Q
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13215-2206
Practice Address - Country:US
Practice Address - Phone:315-492-5765
Practice Address - Fax:315-492-5123
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2008-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF303045363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02526209Medicaid
NY02526209Medicaid
NYRA5359Medicare PIN
NYQ24011Medicare UPIN