Healthcare Provider Details

I. General information

NPI: 1750580908
Provider Name (Legal Business Name): GERALDINE MARY KENNY NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: GERALDINE MARY HIGGINS NP

II. Dates (important events)

Enumeration Date: 07/17/2007
Last Update Date: 04/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45 READE PL
POUGHKEEPSIE NY
12601-3947
US

IV. Provider business mailing address

45 READE PL
POUGHKEEPSIE NY
12601-3947
US

V. Phone/Fax

Practice location:
  • Phone: 845-483-6217
  • Fax: 845-483-6108
Mailing address:
  • Phone: 845-483-6217
  • Fax: 845-483-6108

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number335281
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: