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General NPI Number Information
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NPI Number | 1881202612
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Entity Type | Individual
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Provider Name | KOULAKO CAMARA NP
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Gender | Female
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Dates
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Enumeration Date | 07/17/2020
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Last Update Date | 08/31/2021
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Provider Practice Location Address
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Address Line | 10 WOODS RD
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City | VALHALLA
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State | NY
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Zip | 10595-1529
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Country | US
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Telephone | 914-231-1085
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Fax |
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Provider Business Mailing Address
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Address Line | 15 SHERWOOD DR
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City | POUGHKEEPSIE
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State | NY
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Zip | 12603-6007
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Country | US
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Telephone | 845-803-3500
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 345691
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 345691
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License Number State | NY
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