MEDICARE: MRS. CAROLYN MOBLEY KUYKENDALL APRN, FNP-C, CPNP-AC

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	363L00000X	Nurse Practitioner	AP136125	TX
2	363LF0000X	Family Nurse Practitioner	F346211	NY
3	363LF0000X	Family Nurse Practitioner	AP136125	TX
4	363LP0222X	Critical Care Pediatric Nurse Practitioner	F383143	NY
5	363LP0222X	Critical Care Pediatric Nurse Practitioner	AP136125	TX
6	363L00000X	Nurse Practitioner	F346211	NY

General Provider Information

NPI Number	:	1467670174
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CAROLYN MOBLEY KUYKENDALL APRN, FNP-C, CPNP-AC

Provider Business Mailing Address
First Line	:	605 W 42ND ST APT 26R
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10036-2080
Country	:	US
Telephone Number	:	214-505-0363
Fax Number	:

Provider Business Practice Location Address
First Line	:	2715 30TH AVE
Second Line	:
City	:	ASTORIA
State	:	NY
Zip	:	11102-2445
Country	:	US
Telephone Number	:	718-685-2300
Fax Number	:

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

Provider Enumeration Date	:	04/20/2007
Last Update Date	:	05/22/2024

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