Individual provider Active NPI

Susanna Clare Fenton, NPWH

  • Women's Health Nurse Practitioner
  • Kingston, NY
National Provider Identifier
1740987783
Registry record updated Feb 9, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Women's Health Nurse PractitionerTaxonomy code 363LW0102X
License
F421630-01 Issued in NY
Practice address
21 Grand St
Kingston, NY 12401-3933
Phone
(845) 562-7800
NPI assigned
Feb 9, 2023
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 9, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Women's Health Nurse Practitioner 363LW0102X F421630-01 NY Primary

Addresses

Primary practice location

21 Grand St
Kingston, NY 12401-3933

Mailing address

190 Huguenot St
New Paltz, NY 12561-1018
Phone (845) 399-0245

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
I20230321000557 NY Practitioner - Nurse Practitioner 7214301928 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2022
Medicare assignment
May accept Medicare assignment
Group practices
Planned Parenthood of Greater New York IncGroup PAC ID 7810293297, 34 clinicians

Practice addresses (Care Compare)

21 Grand St
Kingston, NY 12401-3933
Phone (516) 750-2500

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
F421630-01NYMDWomen's Health Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Planned Parenthood of Greater New York Inc CurrentSince Mar 1, 2023 Accepting new patients
Planned Parenthood of the Southern Finger Lakes Inc. Past Accepting new patients

Locations

44 Court St
Fl 6
Brooklyn, NY 11201
Phone (718) 852-6879

400 N Perry St
Johnstown, NY 12095
Phone (518) 284-3570

21 Grand St
Kingston, NY 12401
Phone (845) 338-0840

2141 45th Rd
Long Island City, NY 11101
Phone (212) 965-7000

136 Lake St
Ste 11
Newburgh, NY 12550
Phone (845) 471-1530

17 Noxon St
Poughkeepsie, NY 12601
Phone (845) 471-1530

26 Bleecker St
Prince, NY 10012
Phone (212) 274-7226

543 Bay Rd
Queensbury, NY 12804
Phone (518) 761-2663

236 Washington St
Saratoga Springs, NY 12866
Phone (518) 584-0041

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1675900800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1675900800000",
    "number": "1740987783",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "190 HUGUENOT ST",
            "city": "NEW PALTZ",
            "state": "NY",
            "postal_code": "125611018",
            "telephone_number": "845-399-0245"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "21 GRAND ST",
            "city": "KINGSTON",
            "state": "NY",
            "postal_code": "124013933",
            "telephone_number": "845-562-7800"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FENTON",
        "first_name": "SUSANNA",
        "middle_name": "CLARE",
        "name_prefix": "Ms.",
        "credential": "NPWH",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-02-09",
        "last_updated": "2023-02-09",
        "certification_date": "2023-02-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LW0102X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Women's Health",
            "state": "NY",
            "license": "F421630-01",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Kingston, NY

Sources for this page

Verify at the official NPI Registry.