Individual provider Active NPI

Kailene Leila Tedford, FNP

  • Family Nurse Practitioner
  • Plattsburgh, NY
National Provider Identifier
1558096057
Registry record updated Dec 29, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
350122 Issued in NY
Practice address
87 Plaza Blvd
Plattsburgh, NY 12901-6438
Phone
(518) 536-7060
Fax
(518) 536-7075
NPI assigned
Jul 19, 2022
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 29, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 350122 NY Primary

Addresses

Primary practice location

87 Plaza Blvd
Plattsburgh, NY 12901-6438

Mailing address

9 Carey Rd
Queensbury, NY 12804-7880
Phone (518) 761-0300

Other identifiers 1

IdentifierTypeStateIssuer
07468688MedicaidNY

Other names 1

  • Kailene Leila Jones Former name

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address kailene.tedford.1@1823.direct.athenahealth.com

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
I20221025002062 NY Practitioner - Nurse Practitioner 7214303791 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2022
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Hudson Headwaters Health NetworkGroup PAC ID 7416861208, 221 clinicians

Practice addresses (Care Compare)

87 Plaza Blvd
Plattsburgh, NY 12901-6438
Phone (518) 536-7060

Hospital & facility affiliations

  • The University of Vermont Health Network - Champl Hospital, Plattsburgh, NY, CCN 330250

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Hudson Headwaters Health Network CurrentSince Sep 26, 2022 Accepting new patients
Hudson Headwaters Health Network Current Accepting new patients
Hudson Headwaters Health Network CurrentSince Sep 26, 2022 Accepting new patients
Hudson Headwaters Health Network Past Accepting new patients

Locations

828 State Route 11
Champlain, NY 12919
Phone (518) 298-2691

87 Plaza Blvd
Plattsburgh, NY 12901
Phone (518) 536-7060

9 Carey Rd
Queensbury, NY 12804

Interoperability endpoints

  • Direct secure messaging: kailene.tedford.1@1823.direct.athenahealth.com

Organizations & group practices 4

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 1

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": "1658188800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1766966400000",
    "number": "1558096057",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9 CAREY RD",
            "city": "QUEENSBURY",
            "state": "NY",
            "postal_code": "128047880",
            "telephone_number": "518-761-0300"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "87 PLAZA BLVD",
            "city": "PLATTSBURGH",
            "state": "NY",
            "postal_code": "129016438",
            "telephone_number": "518-536-7060",
            "fax_number": "518-536-7075"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TEDFORD",
        "first_name": "KAILENE",
        "middle_name": "LEILA",
        "credential": "FNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-07-19",
        "last_updated": "2025-12-29",
        "certification_date": "2025-12-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NY",
            "license": "350122",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "07468688",
            "state": "NY"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "kailene.tedford.1@1823.direct.athenahealth.com",
            "affiliation": "N",
            "address_1": "87 Plaza Blvd",
            "city": "Plattsburgh",
            "state": "NY",
            "country_code": "US",
            "postal_code": "129016438",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "KAILENE",
            "last_name": "JONES",
            "middle_name": "LEILA",
            "credential": "FNP",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Plattsburgh, NY

Sources for this page

Verify at the official NPI Registry.