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General NPI Number Information
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NPI Number | 1770640641
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Entity Type | Individual
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Provider Name | KATHLEEN ANN FOLEY ROOT RN ANP
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Gender | Female
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Dates
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Enumeration Date | 01/02/2007
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 50 ROUTE 25A
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City | SMITHTOWN
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State | NY
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Zip | 11787-1348
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Country | US
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Telephone | 631-862-3890
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Fax |
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Provider Business Mailing Address
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Address Line | 4 HARBOR CT
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City | CENTERPORT
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State | NY
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Zip | 11721-1105
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Country | US
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Telephone | 631-754-7360
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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 | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 389982-1
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | F301576-1
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License Number State | NY
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