Provider Demographics
NPI:1821454596
Name:VANNOY, KATHLENE CM (FNP)
Entity Type:Individual
Prefix:
First Name:KATHLENE
Middle Name:CM
Last Name:VANNOY
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:KATHLENE
Other - Middle Name:
Other - Last Name:NASSIF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1591 JACKSON ST APT 18
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94109-3151
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:101 GREENWICH ST STE 403
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10006-1895
Practice Address - Country:US
Practice Address - Phone:917-261-4414
Practice Address - Fax:917-261-4420
Is Sole Proprietor?:No
Enumeration Date:2016-01-11
Last Update Date:2021-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA106955363L00000X
NV832676363L00000X
VA0024179743363L00000X
WV106955363L00000X
CA5008291363L00000X
DCRN1058968363L00000X
NC5008291363L00000X
MDR245037363L00000X
DELG-0011488363L00000X
NJ26NJ01169500363L00000X
IL209.022562363L00000X
AZ247775363L00000X
CT9193363L00000X
TX1008379363L00000X
NY347317363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner