Kelly Marie Labouf

Primary specialty

Licensed Practical NurseTaxonomy code 164W00000X

License

284963 Issued in NY

Practice address

393 Wagner St Lot 81
Waterloo, NY 13165-6709

Phone

(607) 662-5705

Fax

(607) 662-5705

NPI assigned

May 17, 2017

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Kelly Janack Other name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1494979200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1494979200000",
    "number": "1346777612",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "393 WAGNER ST LOT 81",
            "city": "WATERLOO",
            "state": "NY",
            "postal_code": "131656709",
            "telephone_number": "607-662-5705"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "393 WAGNER ST LOT 81",
            "city": "WATERLOO",
            "state": "NY",
            "postal_code": "131656709",
            "telephone_number": "607-662-5705",
            "fax_number": "607-662-5705"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LABOUF",
        "first_name": "KELLY",
        "middle_name": "MARIE",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2017-05-17",
        "last_updated": "2017-05-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "164W00000X",
            "taxonomy_group": "",
            "desc": "Licensed Practical Nurse",
            "state": "NY",
            "license": "284963",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KELLY",
            "last_name": "JANACK",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Ann E Knoll, MS, LMHC
• Roberta L. Korich, N.P.
• Michael Robert Kozlowski, DO
• Chersti Kate Kuhlmann
• Yecham Kumaraswamy, B.PHARM
• Sarah Lahr
• Mary Lou Lang
• Stephanie Lynne Leddy, LPN
• David P Lee, LMSW
• Sarah E Levis, LMSW

• Licensed Practical Nurse in Waterloo, NY
• Providers in Waterloo, NY by specialty
• Licensed Practical Nurse in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 17, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.