Healthcare Provider Details

I. General information

NPI: 1467670174
Provider Name (Legal Business Name): CAROLYN MOBLEY KUYKENDALL APRN, FNP-C, CPNP-AC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: CAROLYN ELIZABETH MOBLEY FNP-C, CPNP-AC

II. Dates (important events)

Enumeration Date: 04/20/2007
Last Update Date: 05/22/2024
Certification Date: 05/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2715 30TH AVE
ASTORIA NY
11102-2445
US

IV. Provider business mailing address

605 W 42ND ST APT 26R
NEW YORK NY
10036-2080
US

V. Phone/Fax

Practice location:
  • Phone: 718-685-2300
  • Fax:
Mailing address:
  • Phone: 214-505-0363
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAP136125
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF346211
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP136125
License Number StateTX
# 4
Primary TaxonomyN
Taxonomy Code363LP0222X
TaxonomyCritical Care Pediatric Nurse Practitioner
License NumberF383143
License Number StateNY
# 5
Primary TaxonomyN
Taxonomy Code363LP0222X
TaxonomyCritical Care Pediatric Nurse Practitioner
License NumberAP136125
License Number StateTX
# 6
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberF346211
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: