Healthcare Provider Details

I. General information

NPI: 1063137040
Provider Name (Legal Business Name): SIOBHAN K KEARNS NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/11/2022
Last Update Date: 05/27/2026
Certification Date: 05/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

153 BARBARA RD
BELLMORE NY
11710-4702
US

IV. Provider business mailing address

153 BARBARA RD
BELLMORE NY
11710-4702
US

V. Phone/Fax

Practice location:
  • Phone: 516-969-8160
  • Fax: 516-518-0478
Mailing address:
  • Phone: 516-225-6719
  • Fax: 516-842-9708

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberF404499
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: