Provider Demographics
NPI:1669177648
Name:SEYMOUR, KIMBERLEY LEE (FNP)
Entity type:Individual
Prefix:
First Name:KIMBERLEY
Middle Name:LEE
Last Name:SEYMOUR
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 1:214 CORNELIA ST STE 203
Mailing Address - Street 2:
Mailing Address - City:PLATTSBURGH
Mailing Address - State:NY
Mailing Address - Zip Code:12901-2332
Mailing Address - Country:US
Mailing Address - Phone:518-314-3242
Mailing Address - Fax:
Practice Address - Street 1:214 CORNELIA ST STE 203
Practice Address - Street 2:
Practice Address - City:PLATTSBURGH
Practice Address - State:NY
Practice Address - Zip Code:12901-2332
Practice Address - Country:US
Practice Address - Phone:518-314-3242
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-31
Last Update Date:2023-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY351293363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily