Healthcare Provider Details

I. General information

NPI: 1881705515
Provider Name (Legal Business Name): KATHLEEN A ESPEY RN,ANP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 04/16/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

286 STAGE RD
CHARLTON NY
12019-2619
US

IV. Provider business mailing address

286 STAGE RD
CHARLTON NY
12019-2619
US

V. Phone/Fax

Practice location:
  • Phone: 518-399-2101
  • Fax: 518-399-2130
Mailing address:
  • Phone: 518-399-2101
  • Fax: 518-399-2130

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberF300639
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: