Healthcare Provider Details

I. General information

NPI: 1467994608
Provider Name (Legal Business Name): KIMBERLEE BARRESI AGNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/04/2016
Last Update Date: 01/29/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

207 GLEN COVE AVE
SEA CLIFF NY
11579-1455
US

IV. Provider business mailing address

207 GLEN COVE AVE
SEA CLIFF NY
11579-1455
US

V. Phone/Fax

Practice location:
  • Phone: 516-676-1742
  • Fax:
Mailing address:
  • Phone: 516-676-1742
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberF307923-1
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberF307923-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: