Healthcare Provider Details

I. General information

NPI: 1629550041
Provider Name (Legal Business Name): KAREN A BEDELL FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/01/2018
Last Update Date: 02/14/2020
Certification Date: 02/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3305 ROUTE 43
AVERILL PARK NY
12018
US

IV. Provider business mailing address

711 TROY SCHENECTADY RD STE 203
LATHAM NY
12110-2461
US

V. Phone/Fax

Practice location:
  • Phone: 518-674-5797
  • Fax: 518-674-2396
Mailing address:
  • Phone: 518-782-3700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF343147-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: