MEDICARE: KALEDISCOPE NP IN FAMILY HEALTH AND PSYCHIATRY PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner
2	363LF0000X	Family Nurse Practitioner

General Provider Information

NPI Number	:	1205768561
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KALEDISCOPE NP IN FAMILY HEALTH AND PSYCHIATRY PLLC

Provider Business Mailing Address
First Line	:	846 DEAN DR
Second Line	:
City	:	NORTH BALDWIN
State	:	NY
Zip	:	11510-1109
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	846 DEAN DRIVE
Second Line	:
City	:	BALDWIN
State	:	NY
Zip	:	11510
Country	:	US
Telephone Number	:	516-543-3935
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	KRISTLE LEE SIMMS-MURPHY
Credential	:	NP
Telephone Number	:	347-612-1575

Provider Enumeration Date	:	06/01/2026
Last Update Date	:	06/01/2026

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