Individual provider Active NPI

Kelly Ann Yale-Suda, RN, GRADUATE NP

  • Adult Health Nurse Practitioner
  • Johnson City, NY
National Provider Identifier
1447872817
Registry record updated Nov 18, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Health Nurse PractitionerTaxonomy code 363LA2200X
License
309912 Issued in NY
Practice address
30 Harrison St Ste 355
Johnson City, NY 13790-2162
Phone
(607) 763-8102
Fax
(607) 763-8018
NPI assigned
May 8, 2020
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 18, 2025

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Adult Health Nurse Practitioner 363LA2200X 309912 NY Primary
Nurse Practitioner 363L00000X 309912 NY
Registered Nurse 163W00000X 587887 NY

Addresses

Primary practice location

30 Harrison St Ste 355
Johnson City, NY 13790-2162

Mailing address

169 Riverside Dr
Binghamton, NY 13905-4246
Phone (607) 352-3550

Other practice location 1

169 Riverside Dr
Binghamton, NY 13905-4246
Phone (607) 352-3550

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20201009000233 NY Practitioner - Nurse Practitioner 5799105938 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

169 Riverside Dr
Suite 206
Binghamton, NY 13905-4246
Phone (607) 798-6701

30 Harrison St
Suite 355
Johnson City, NY 13790-2162
Phone (607) 770-1018

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner, Registered Nurse

State licenses

LicenseStateTypeSpecialty
587887NYMDRegistered Nurse

Practice roles

OrganizationSpecialtyStatusNew patients
Twin Tier Pathology Associates, PC Current Accepting new patients
United Health Services Hospitals, Inc. CurrentSince Jan 4, 2026 Accepting new patients
Our Lady of Lourdes Memorial Hospital, Inc. CurrentSince Sep 16, 2020 Accepting new patients
Our Lady of Lourdes Memorial Hospital, Inc. Nurse Practitioner Current Accepting new patients
Our Lady of Lourdes Memorial Hospital Inc. CurrentSince Sep 16, 2020 Accepting new patients

Locations

169 Riverside Dr
Binghamton, NY 13905
Phone (607) 798-5111

169 Riverside Dr
Ste 206
Binghamton, NY 13905
Phone (607) 798-6701

30 Harrison St
Ste 355
Johnson City, NY 13790
Phone (607) 763-6554

Interoperability endpoints

  • Direct secure messaging: kyalesuda196737@direct-guthrie.org

Organizations & group practices 5

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.

Hospital & facility affiliations 2

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1588896000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1763424000000",
    "number": "1447872817",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "169 RIVERSIDE DR",
            "city": "BINGHAMTON",
            "state": "NY",
            "postal_code": "139054246",
            "telephone_number": "607-352-3550"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "30 HARRISON ST STE 355",
            "city": "JOHNSON CITY",
            "state": "NY",
            "postal_code": "137902162",
            "telephone_number": "607-763-8102",
            "fax_number": "607-763-8018"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "169 Riverside Dr",
            "address_purpose": "LOCATION",
            "city": "Binghamton",
            "state": "NY",
            "postal_code": "139054246",
            "country_code": "US",
            "telephone_number": "607-352-3550",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "YALE-SUDA",
        "first_name": "KELLY",
        "middle_name": "ANN",
        "credential": "RN, GRADUATE NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-05-08",
        "last_updated": "2025-11-18",
        "certification_date": "2025-11-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "NY",
            "license": "309912",
            "primary": true
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "NY",
            "license": "309912",
            "primary": false
        },
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "NY",
            "license": "587887",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Johnson City, NY

Sources for this page

Verify at the official NPI Registry.