Healthcare Provider Details

I. General information

NPI: 1447789490
Provider Name (Legal Business Name): KIMBERLEY AUGUSTIN FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2017
Last Update Date: 06/29/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6200 BEACH CHANNEL DR
ARVERNE NY
11692
US

IV. Provider business mailing address

10939 134TH ST
SOUTH OZONE PARK NY
11420-1807
US

V. Phone/Fax

Practice location:
  • Phone: 718-945-7150
  • Fax:
Mailing address:
  • Phone: 917-817-7753
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF341694
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: