=====================================================
General NPI Number Information
=====================================================
NPI Number | 1205245313
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ERIN KEARNS PA
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/04/2014
-----------------------------------------------------
Last Update Date | 04/30/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 875 PRE EMPTION RD
-----------------------------------------------------
City | GENEVA
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 14456
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 315-789-5061
-----------------------------------------------------
Fax | 315-789-5071
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 875 PRE EMPTION RD
-----------------------------------------------------
City | GENEVA
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 14456-2042
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363AS0400X
-----------------------------------------------------
Taxonomy Name | Surgical Physician Assistant
-----------------------------------------------------
License Number | 017607
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------