Provider Demographics
NPI:1821585274
Name:MYE, KATHRYN CAREY (NP)
Entity Type:Individual
Prefix:MRS
First Name:KATHRYN
Middle Name:CAREY
Last Name:MYE
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 1:30 N UNION RD STE 101
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221-5367
Mailing Address - Country:US
Mailing Address - Phone:716-633-6363
Mailing Address - Fax:716-204-5260
Practice Address - Street 1:30 N UNION RD STE 101
Practice Address - Street 2:
Practice Address - City:WILLIAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14221-5367
Practice Address - Country:US
Practice Address - Phone:716-633-6363
Practice Address - Fax:716-204-5260
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-20
Last Update Date:2019-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF342471-1207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty