Provider Demographics
NPI:1356880066
Name:DUIGNAN, KAITLIN J (FNP)
Entity type:Individual
Prefix:
First Name:KAITLIN
Middle Name:J
Last Name:DUIGNAN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:412 MERRICK RD
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE CENTRE
Mailing Address - State:NY
Mailing Address - Zip Code:11570-5427
Mailing Address - Country:US
Mailing Address - Phone:516-395-7302
Mailing Address - Fax:
Practice Address - Street 1:222 STATION PLZ N STE 104
Practice Address - Street 2:
Practice Address - City:MINEOLA
Practice Address - State:NY
Practice Address - Zip Code:11501-3800
Practice Address - Country:US
Practice Address - Phone:516-663-1500
Practice Address - Fax:516-663-1877
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-14
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF341424-1363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY04749804Medicaid