Kathleen Danielle Ennis, NP

Primary specialty

Pediatric Nurse PractitionerTaxonomy code 363LP0200X

License

383572 Issued in NY

Practice address

4900 Broad Rd
Syracuse, NY 13215-2265

Phone

(315) 492-5011

NPI assigned

May 6, 2021

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Interoperability endpoints

• Direct secure messaging: kennis78963@direct.upstate.edu

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Suny Health Science Center at Syracuse

  • General Acute Care Hospital
  • Syracuse, NY
  • NPI 1578554630
  NPD (past)

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

{
    "created_epoch": "1620259200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1686787200000",
    "number": "1407430341",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "38 SENECA ST",
            "city": "BALDWINSVILLE",
            "state": "NY",
            "postal_code": "13027"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4900 BROAD RD",
            "city": "SYRACUSE",
            "state": "NY",
            "postal_code": "132152265",
            "telephone_number": "315-492-5011"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "97 Patricia Dr",
            "address_purpose": "LOCATION",
            "city": "Syracuse",
            "state": "NY",
            "postal_code": "132124272",
            "country_code": "US",
            "telephone_number": "315-383-5050",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "38 Seneca St",
            "address_purpose": "LOCATION",
            "city": "Baldwinsville",
            "state": "NY",
            "postal_code": "130272809",
            "country_code": "US",
            "telephone_number": "315-559-1371",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ENNIS",
        "first_name": "KATHLEEN",
        "middle_name": "DANIELLE",
        "credential": "NP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-05-06",
        "last_updated": "2023-06-15",
        "certification_date": "2023-06-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WN0002X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Neonatal Intensive Care",
            "state": "NY",
            "license": "773322",
            "primary": false
        },
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "NY",
            "license": "383572",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Mabel Eng - Moriarty, M.D.
• David Y Eng, MD
• Engage PT OT and SLP
• Virginia A Engan, RN
• Alexandra B English, PA
• Jessica Ann Eno, PA-C
• Lindsey Ensher
• Alexis Mei-Li Entz
• Lawrencia I Enyioha
• Epc Physicians PLLC

• Pediatric Nurse Practitioner in Syracuse, NY
• Providers in Syracuse, NY by specialty
• Pediatric Nurse Practitioner in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 15, 2023; 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.