Healthcare Provider Details

I. General information

NPI: 1669063566
Provider Name (Legal Business Name): KATHLEEN MICHELE KIZZEE AGPCNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/02/2021
Last Update Date: 06/09/2026
Certification Date: 06/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5075 W SENECA TPKE
SYRACUSE NY
13215-3216
US

IV. Provider business mailing address

122 MARIAN DR
MATTYDALE NY
13211-1826
US

V. Phone/Fax

Practice location:
  • Phone: 315-449-6000
  • Fax:
Mailing address:
  • Phone: 315-289-5092
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number308963
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: