Provider Demographics
NPI:1871257584
Name:PACHECO, KERRY LYNN (NP)
Entity Type:Individual
Prefix:
First Name:KERRY
Middle Name:LYNN
Last Name:PACHECO
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
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Other - Middle Name:
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Mailing Address - Street 1:100 KINGS HWY S
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14617-5504
Mailing Address - Country:US
Mailing Address - Phone:585-922-4020
Mailing Address - Fax:585-922-4622
Practice Address - Street 1:20 HAGEN DR STE 100
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14625-2665
Practice Address - Country:US
Practice Address - Phone:585-922-4020
Practice Address - Fax:585-922-4622
Is Sole Proprietor?:No
Enumeration Date:2021-10-28
Last Update Date:2022-12-22
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY310446363LG0600X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology