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General NPI Number Information
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NPI Number | 1568002038
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Entity Type | Individual
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Provider Name | KAITLYN ELLERT NP
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Gender | Female
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Dates
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Enumeration Date | 01/13/2020
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Last Update Date | 03/11/2022
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Provider Practice Location Address
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Address Line | 900 WASHINGTON RD
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City | WEST POINT
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State | NY
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Zip | 10996-1109
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Country | US
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Telephone | 845-938-1352
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Fax |
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Provider Business Mailing Address
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Address Line | 43 WOODBURY RD
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City | HIGHLAND MILLS
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State | NY
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Zip | 10930-2406
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Country | US
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Telephone | 845-570-0607
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | 309505
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License Number State | NY
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