Healthcare Provider Details

I. General information

NPI: 1093705873
Provider Name (Legal Business Name): WENDY KENT FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/24/2005
Last Update Date: 04/24/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 HOBART ST
UTICA NY
13501-4308
US

IV. Provider business mailing address

2209 GENESEE STREET BUSINESS OFFICE ROOM 310
UTICA NY
13501-5930
US

V. Phone/Fax

Practice location:
  • Phone: 315-801-1149
  • Fax: 315-801-3565
Mailing address:
  • Phone: 315-801-3282
  • Fax: 315-801-8391

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number255571-1
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF331431-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: