Healthcare Provider Details

I. General information

NPI: 1437368701
Provider Name (Legal Business Name): KARA TIMMINS PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/22/2007
Last Update Date: 07/18/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 PROSPECT AVE CLINICAL AFFILIATES
SYRACUSE NY
13203-1807
US

IV. Provider business mailing address

104 UNION AVE SUITE 804
SYRACUSE NY
13203-1843
US

V. Phone/Fax

Practice location:
  • Phone: 315-448-5111
  • Fax: 315-703-5049
Mailing address:
  • Phone: 315-703-5049
  • Fax: 315-703-5079

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number011718
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number011718
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: