Healthcare Provider Details

I. General information

NPI: 1760123301
Provider Name (Legal Business Name): MOLLY KILMURRAY FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MISS MOLLY COOK

II. Dates (important events)

Enumeration Date: 04/06/2022
Last Update Date: 04/06/2022
Certification Date: 04/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2950 ELMWOOD AVE
KENMORE NY
14217-1304
US

IV. Provider business mailing address

125 CLOVERSIDE CT
BUFFALO NY
14224-2947
US

V. Phone/Fax

Practice location:
  • Phone: 716-447-6100
  • Fax:
Mailing address:
  • Phone: 845-702-3682
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF349147-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: