Kimberly Nicole Charles, FNP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

337723 Issued in NY

Practice address

1999 Marcus Ave
Suite 116
Lake Success, NY 11042

Phone

(516) 403-1550

Fax

(516) 403-1551

NPI assigned

Feb 6, 2013

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Electronic endpoints 1

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

Medicare enrollment (NPD)

Enrolled

State licenses

Interoperability endpoints

• Direct secure messaging: kgriffith36081@nyumc.direct-ci.com

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

{
    "created_epoch": "1360108800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1617580800000",
    "number": "1982943254",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1999 MARCUS AVE",
            "address_2": "SUITE 116",
            "city": "NEW HYDE PARK",
            "state": "NY",
            "postal_code": "110421033",
            "telephone_number": "516-403-1550"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1999 MARCUS AVE",
            "address_2": "SUITE 116",
            "city": "LAKE SUCCESS",
            "state": "NY",
            "postal_code": "11042",
            "telephone_number": "516-403-1550",
            "fax_number": "516-403-1551"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CHARLES",
        "first_name": "KIMBERLY",
        "middle_name": "NICOLE",
        "credential": "FNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-02-06",
        "last_updated": "2021-04-05",
        "certification_date": "2021-04-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NY",
            "license": "337723",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "kgriffith36081@nyumc.direct-ci.com",
            "affiliation": "N",
            "address_1": "1999 Marcus Ave",
            "address_2": "Suite 116",
            "city": "Lake Success",
            "state": "NY",
            "country_code": "US",
            "postal_code": "11042",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Jane Carleton
• Jessica Caro, M.D.
• Stacie K Castle, RD
• Lynn Talin Cetin, MD
• Hui-Chu Judy Chang, M.D.
• Kunal Kumar Chawla, MD
• Maurice J Chianese, MD
• David W Chitty, DO
• PO Chun Chu, RPH
• Sheri L Coatney, OD

• Family Nurse Practitioner in Lake Success, NY
• Providers in Lake Success, NY by specialty
• Family Nurse Practitioner in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 5, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.