Healthcare Provider Details

I. General information

NPI: 1093417529
Provider Name (Legal Business Name): KATELYN POMEROY NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KATELYN FABIAN

II. Dates (important events)

Enumeration Date: 03/20/2023
Last Update Date: 12/19/2025
Certification Date: 12/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1302 E MAIN ST
ENDICOTT NY
13760-5430
US

IV. Provider business mailing address

33 LEWIS RD FL 2
BINGHAMTON NY
13905
US

V. Phone/Fax

Practice location:
  • Phone: 607-754-7171
  • Fax:
Mailing address:
  • Phone: 607-770-0025
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number352089
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: