Provider Demographics
NPI:1811990856
Name:KOLTON, KATHRYN A (FNP)
Entity type:Individual
Prefix:MS
First Name:KATHRYN
Middle Name:A
Last Name:KOLTON
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 1:53-59 PUBLIC SQ
Mailing Address - Street 2:STE 301
Mailing Address - City:WATERTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:13601-2674
Mailing Address - Country:US
Mailing Address - Phone:315-782-2141
Mailing Address - Fax:315-782-5123
Practice Address - Street 1:53-59 PUBLIC SQ
Practice Address - Street 2:STE 301
Practice Address - City:WATERTOWN
Practice Address - State:NY
Practice Address - Zip Code:13601-2674
Practice Address - Country:US
Practice Address - Phone:315-782-2141
Practice Address - Fax:315-782-5123
Is Sole Proprietor?:No
Enumeration Date:2005-05-23
Last Update Date:2007-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF331378363LF0000X
NYF300834363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01417885Medicaid
NY7599473OtherGHI
NYR53860Medicare UPIN
NYCC4955Medicare PIN
NYCC4955Medicare ID - Type Unspecified