Healthcare Provider Details

I. General information

NPI: 1811990856
Provider Name (Legal Business Name): KATHRYN A KOLTON FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2005
Last Update Date: 10/25/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

53-59 PUBLIC SQ STE 301
WATERTOWN NY
13601-2674
US

IV. Provider business mailing address

53-59 PUBLIC SQ STE 301
WATERTOWN NY
13601-2674
US

V. Phone/Fax

Practice location:
  • Phone: 315-782-2141
  • Fax: 315-782-5123
Mailing address:
  • Phone: 315-782-2141
  • Fax: 315-782-5123

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF331378
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberF300834
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: