Healthcare Provider Details

I. General information

NPI: 1619817434
Provider Name (Legal Business Name): KELSEE GARRETT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/31/2026
Last Update Date: 03/31/2026
Certification Date: 03/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

90 E MAIN ST
PATCHOGUE NY
11772-3176
US

IV. Provider business mailing address

7 HEGEMAN AVE APT 12H
BROOKLYN NY
11212-4744
US

V. Phone/Fax

Practice location:
  • Phone: 888-722-2072
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number355003
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: