Healthcare Provider Details

I. General information

NPI: 1538651237
Provider Name (Legal Business Name): COURTNEY MONICA KESSEL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/30/2018
Last Update Date: 06/22/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

951 NIAGARA ST
BUFFALO NY
14213
US

IV. Provider business mailing address

951 NIAGARA ST
BUFFALO NY
14213-2116
US

V. Phone/Fax

Practice location:
  • Phone: 716-884-0700
  • Fax: 716-884-0631
Mailing address:
  • Phone: 716-884-0700
  • Fax: 716-884-0631

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number402411
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: