=====================================================
General NPI Number Information
=====================================================
NPI Number | 1386206365
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KAYLYN ELIZABETH AMUSO APRN, FNP-C
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/01/2019
-----------------------------------------------------
Last Update Date | 08/15/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 260 TOWNSHIP BLVD STE 20
-----------------------------------------------------
City | CAMILLUS
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 13031-1678
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 315-708-0190
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 260 TOWNSHIP BLVD STE 20
-----------------------------------------------------
City | CAMILLUS
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 13031-1678
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 315-708-0190
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | 344461
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------