Healthcare Provider Details

I. General information

NPI: 1598722365
Provider Name (Legal Business Name): KIMBERLY MACDONALD F.N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/27/2006
Last Update Date: 10/23/2023
Certification Date: 10/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6255 SHERIDAN DR STE 200
WILLIAMSVILLE NY
14221-4825
US

IV. Provider business mailing address

6255 SHERIDAN DR STE 200
WILLIAMSVILLE NY
14221-4825
US

V. Phone/Fax

Practice location:
  • Phone: 716-636-7979
  • Fax: 716-929-0192
Mailing address:
  • Phone: 716-636-7979
  • Fax: 716-929-0192

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF332135
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: