MEDICARE: DR. KERRIE LEIGH NESBITT AU.D.

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	231H00000X	Audiologist	002278-1	NY

General Provider Information

NPI Number	:	1487988572
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KERRIE LEIGH NESBITT AU.D.

Provider Business Mailing Address
First Line	:	2984 US ROUTE 11
Second Line	:	APARTMENT J37
City	:	LA FAYETTE
State	:	NY
Zip	:	13084-9627
Country	:	US
Telephone Number	:	315-416-2486
Fax Number	:

Provider Business Practice Location Address
First Line	:	221 BROAD ST
Second Line	:	SUITE 201
City	:	ONEIDA
State	:	NY
Zip	:	13421-2178
Country	:	US
Telephone Number	:	315-363-3310
Fax Number	:	315-363-5472

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

Provider Enumeration Date	:	09/23/2009
Last Update Date	:	09/23/2009

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