Healthcare Provider Details

I. General information

NPI: 1558038372
Provider Name (Legal Business Name): KYRA CATHERINE HOLLAND
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KYRA CATHERINE SCAGLIONE FNP-BC

II. Dates (important events)

Enumeration Date: 08/28/2021
Last Update Date: 11/26/2021
Certification Date: 11/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

707 E MAIN ST
MIDDLETOWN NY
10940-2650
US

IV. Provider business mailing address

707 E MAIN ST
MIDDLETOWN NY
10940-2650
US

V. Phone/Fax

Practice location:
  • Phone: 845-333-7575
  • Fax: 845-333-7201
Mailing address:
  • Phone: 845-333-7575
  • Fax: 845-333-7201

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number347724
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: