Healthcare Provider Details

I. General information

NPI: 1265887988
Provider Name (Legal Business Name): KYMARA KYNG NURSE PRACTITIONER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/02/2016
Last Update Date: 05/17/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

462 1ST AVE 7N24
NEW YORK NY
10016-9198
US

IV. Provider business mailing address

462 1ST AVE 7N24
NEW YORK NY
10016-9198
US

V. Phone/Fax

Practice location:
  • Phone: 212-263-6479
  • Fax: 212-263-8442
Mailing address:
  • Phone: 212-263-6479
  • Fax: 212-263-8442

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP2201X
TaxonomyAmbulatory Care Registered Nurse
License Number523984-1
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF339521-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: