Healthcare Provider Details

I. General information

NPI: 1962316836
Provider Name (Legal Business Name): KASIYA A LONGMIRE
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/29/2026
Last Update Date: 09/29/2026
Certification Date: 09/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35 NEW HOPE TER
ALBANY NY
12204-1844
US

IV. Provider business mailing address

35 NEW HOPE TER
ALBANY NY
12204-1844
US

V. Phone/Fax

Practice location:
  • Phone: 518-542-0442
  • Fax:
Mailing address:
  • Phone: 518-542-0442
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number337304
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: