Healthcare Provider Details

I. General information

NPI: 1215852181
Provider Name (Legal Business Name): KEARA MARGARET DWYER PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2026
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5100 W TAFT RD
LIVERPOOL NY
13088-3807
US

IV. Provider business mailing address

5100 W TAFT RD
LIVERPOOL NY
13088-3807
US

V. Phone/Fax

Practice location:
  • Phone: 315-452-2828
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN79795
License Number StateME
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN10017508
License Number StateMA
# 3
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number858877
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: