Provider Demographics
NPI:1245278969
Name:BRATT, KATHLEEN A (NP)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:A
Last Name:BRATT
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:KATHLEEN
Other - Middle Name:
Other - Last Name:CHAPMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3229 E GENESEE ST
Mailing Address - Street 2:JOSLIN CENTER
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13214-2016
Mailing Address - Country:US
Mailing Address - Phone:315-464-5726
Mailing Address - Fax:315-464-2500
Practice Address - Street 1:3229 E GENESEE ST
Practice Address - Street 2:JOSLIN CENTER
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13214-2016
Practice Address - Country:US
Practice Address - Phone:315-464-5726
Practice Address - Fax:315-464-2500
Is Sole Proprietor?:No
Enumeration Date:2006-06-03
Last Update Date:2010-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY381246363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02117251Medicaid
NYJ400009838Medicare PIN
NY02117251Medicaid