Healthcare Provider Details

I. General information

NPI: 1801249735
Provider Name (Legal Business Name): AMANDA KINSMAN NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/15/2016
Last Update Date: 07/15/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 STEUBEN ST
MONTOUR FALLS NY
14865-9740
US

IV. Provider business mailing address

220 STEUBEN ST
MONTOUR FALLS NY
14865-9740
US

V. Phone/Fax

Practice location:
  • Phone: 607-535-7121
  • Fax: 607-210-1940
Mailing address:
  • Phone: 607-535-7121
  • Fax: 607-210-1940

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number340883
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: