Healthcare Provider Details

I. General information

NPI: 1437297520
Provider Name (Legal Business Name): KIM K CARAWAY CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/02/2007
Last Update Date: 10/09/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

534 W 135TH ST CHARLES B RANGEL COMMUNITY CENTER -DEPT OB/GYN
NEW YORK NY
10031-8601
US

IV. Provider business mailing address

12 MARTIN RD
HOPEWELL JUNCTION NY
12533-5515
US

V. Phone/Fax

Practice location:
  • Phone: 212-491-2300
  • Fax: 212-491-2323
Mailing address:
  • Phone: 646-872-0751
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License NumberF000580
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: