Healthcare Provider Details

I. General information

NPI: 1235337023
Provider Name (Legal Business Name): KYMBERLY M HARVELL N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/03/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 MONTAUK HWY
WEST ISLIP NY
11795-4927
US

IV. Provider business mailing address

20 FERN AVE
EAST ISLIP NY
11730-2111
US

V. Phone/Fax

Practice location:
  • Phone: 631-376-3384
  • Fax: 631-376-4101
Mailing address:
  • Phone: 631-376-3384
  • Fax: 631-376-4101

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberF303296
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: