Provider Demographics
NPI:1740681287
Name:JONES-GAIRY, KANDICE CAMILLE (NP-BC)
Entity type:Individual
Prefix:
First Name:KANDICE
Middle Name:CAMILLE
Last Name:JONES-GAIRY
Suffix:
Gender:F
Credentials:NP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:545 E 142ND ST
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10454-2110
Mailing Address - Country:US
Mailing Address - Phone:718-579-4000
Mailing Address - Fax:
Practice Address - Street 1:545 E 142ND ST
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10454-2110
Practice Address - Country:US
Practice Address - Phone:718-579-4000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-15
Last Update Date:2015-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF307065-1363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health