Provider Demographics
NPI:1851915615
Name:KIRSCHENHEITER, KAYLYN MARIE
Entity Type:Individual
Prefix:
First Name:KAYLYN
Middle Name:MARIE
Last Name:KIRSCHENHEITER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:133 AVENUE D
Mailing Address - Street 2:
Mailing Address - City:HOLBROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11741-2333
Mailing Address - Country:US
Mailing Address - Phone:631-704-3279
Mailing Address - Fax:
Practice Address - Street 1:133 AVENUE D
Practice Address - Street 2:
Practice Address - City:HOLBROOK
Practice Address - State:NY
Practice Address - Zip Code:11741-2333
Practice Address - Country:US
Practice Address - Phone:631-704-3279
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-07
Last Update Date:2020-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY765575-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse