Healthcare Provider Details

I. General information

NPI: 1033635388
Provider Name (Legal Business Name): KAELI JO HARNEY MSN, APRN, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2017
Last Update Date: 01/08/2025
Certification Date: 01/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

930 S SALINA ST
SYRACUSE NY
13202-3530
US

IV. Provider business mailing address

819 S SALINA ST
SYRACUSE NY
13202-3570
US

V. Phone/Fax

Practice location:
  • Phone: 315-404-1961
  • Fax:
Mailing address:
  • Phone: 315-476-7921
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License NumberRN2299048
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF07191506
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: