MEDICARE: MISS KELYNNE J EDMOND GNP-BC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LG0600X	Gerontology Nurse Practitioner	340674	NY

General Provider Information

NPI Number	:	1396918025
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS KELYNNE J EDMOND GNP-BC

Provider Business Mailing Address
First Line	:	498 KOSCIUSZKO ST
Second Line	:	2ND FLOOR
City	:	BROOKLYN
State	:	NY
Zip	:	11221-2308
Country	:	US
Telephone Number	:	646-281-9006
Fax Number	:

Provider Business Practice Location Address
First Line	:	596 PROSPECT PL
Second Line	:	2ND FLOOR
City	:	BROOKLYN
State	:	NY
Zip	:	11238-4205
Country	:	US
Telephone Number	:	718-362-1444
Fax Number	:	718-362-1445

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/02/2008
Last Update Date	:	04/12/2016

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