MEDICARE: ATHENA KOKINOS GALLEGOS FNP-BC

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	363LF0000X	Family Nurse Practitioner	26NJ15584400	NJ
2	363L00000X	Nurse Practitioner	359722	NY

General Provider Information

NPI Number	:	1316876667
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ATHENA KOKINOS GALLEGOS FNP-BC

Provider Business Mailing Address
First Line	:	22 LOUISIANA PKWY
Second Line	:
City	:	JACKSON
State	:	NJ
Zip	:	08527-2145
Country	:	US
Telephone Number	:	732-762-6186
Fax Number	:

Provider Business Practice Location Address
First Line	:	22 LOUISIANA PKWY
Second Line	:
City	:	JACKSON
State	:	NJ
Zip	:	08527-2145
Country	:	US
Telephone Number	:	732-762-6186
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/14/2026
Last Update Date	:	06/02/2026

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