Individual provider Active NPI

Kathleen Grace Landry, PMHNP-BC

  • Psychiatric/Mental Health Nurse Practitioner
  • Gloversville, NY
National Provider Identifier
1831761766
Registry record updated Jul 12, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
License
726977 Issued in NY
Practice address
11 Broadway St
Gloversville, NY 12078
Phone
(518) 428-5888
NPI assigned
Jul 12, 2021
Last updated
Jul 12, 2021By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 12, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric/Mental Health Nurse Practitioner 363LP0808X 726977 NY Primary

Addresses

Primary practice location

11 Broadway St
Gloversville, NY 12078

Mailing address

19 Manor Blvd
Troy, NY 12180-5617
Phone (518) 428-5888

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
I20211214001032 NY Practitioner - Nurse Practitioner 4183014723 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
The Family Counseling Center of Fulton County IncGroup PAC ID 0042283335, 14 clinicians

Practice addresses (Care Compare)

11 -21 Broadway St
Gloversville, NY 12078-3968
Phone (518) 725-4310

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
726977NYMDPsychiatric/Mental Health Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
The Family Counseling Center of Fulton County Inc Psychiatric/Mental Health CurrentSince Nov 1, 2021 Accepting new patients
Grow Healthcare Group PA Psychiatric/Mental Health CurrentSince Nov 21, 2024 Accepting new patients

Locations

11 Broadway St
Gloversville, NY 12078
Phone (518) 725-4310

11-21 Broadway St
Gloversville, NY 12078
Phone (518) 725-4310

165 Broadway
Fl 23
New York, NY 10006
Phone (202) 972-4964

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 4

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": "1626048000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1626048000000",
    "number": "1831761766",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "19 MANOR BLVD",
            "city": "TROY",
            "state": "NY",
            "postal_code": "121805617",
            "telephone_number": "518-428-5888"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11 BROADWAY ST",
            "city": "GLOVERSVILLE",
            "state": "NY",
            "postal_code": "12078",
            "telephone_number": "518-428-5888"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LANDRY",
        "first_name": "KATHLEEN",
        "middle_name": "GRACE",
        "name_prefix": "Ms.",
        "credential": "PMHNP-BC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-07-12",
        "last_updated": "2021-07-12",
        "certification_date": "2021-06-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "NY",
            "license": "726977",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Gloversville, NY

Sources for this page

Verify at the official NPI Registry.