KMC Nurse Practitioner in Adult Health PLLC
Organization Active NPI Adult Health Nurse Practitioner · Clarence, NY
NPI 1295570034 · NPPES record last updated Jul 11, 2024
Key facts
- NPI
- 1295570034
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Adult Health Nurse Practitioner 363LA2200X
- Legal business name
- KMC NURSE PRACTITIONER IN ADULT HEALTH PLLC
- Practice address
- 9097 Main St
Clarence, NY 14031-1965 - Phone
- (716) 759-4938
- Fax
- (716) 759-4939
- NPI assigned
- Jun 25, 2024
- Organization subpart
- No
Authorized official
- Name
- Kym Cannizzaro
- Title
- Owner/NP
- Phone
- (716) 759-4938
Practitioners 1
-
Kym M Cannizzaro, NP
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in NY
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20240715002865 | NY | Part B Supplier - Clinic/Group Practice | 0840735866 |
Receives reassigned benefits from 1 practitioner Practice locations: Amherst, NY |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Adult Health Nurse Practitioner |
363LA2200X | Yes |
Addresses
Primary practice location
9097 Main St
Clarence, NY 14031-1965
Mailing address
9097 Main St
Clarence, NY 14031-1965
Phone (716) 759-4938
Other practice location 1
10175 Niagara Falls Blvd Ste 1
Niagara Falls, NY 14304-2941
Phone (716) 759-4938
Other providers in Clarence, NY
- Danielle Johnston
- Lindsay Karas
- April Kilgour
- David Joseph King
- Kari Klentos
- Stacy Koch
- Sara Kreher
- Lori Theresa Kuhmann
- Richard B Lafountain
- Stephanie B Lanza
All providers in Clarence, NY · Adult Health 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 Jul 11, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.