Kerry Ann Ahern, FNP
Individual provider Active NPI Nurse Practitioner · East Syracuse, NY
NPI 1104055490 · NPPES record last updated Mar 14, 2018
Key facts
- NPI
- 1104055490
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Nurse Practitioner 363L00000X
- License
- 335948 (NY)
- Practice address
- 5008 Brittonfield Pkwy
Suite 700
East Syracuse, NY 13057-9248 - Phone
- (315) 472-7504
- Fax
- (315) 479-8639
- NPI assigned
- Jul 7, 2009
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Nurse Practitioner
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nurse Practitioner | 363L00000X | 335948 | NY | Yes |
Addresses
Primary practice location
5008 Brittonfield Pkwy
Suite 700
East Syracuse, NY 13057-9248
Mailing address
5008 Brittonfield Pkwy
Suite 700
East Syracuse, NY 13057-9248
Phone (315) 472-7504
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 03152825 | Medicaid | NY |
Other names
- Kerry Ahern Johnson
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All providers in East Syracuse, NY · Nurse Practitioner in New York
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 14, 2018. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.