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NPI Code Detail

MEDICARE: KIMBERLY ANNE SLOAN PMHNP

MEDICARE: KIMBERLY ANNE SLOAN PMHNP
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
1163WE0003XEmergency Registered Nurse636163NY
2363LP0808XPsychiatric/Mental Health Nurse Practitioner407397NY
3163WC0200XCritical Care Medicine Registered Nurse636163NY
4163WA2000XAdministrator Registered Nurse636163NY
5163WP0807XChild & Adolescent Psychiatric/Mental Health Registered Nurse636163NY

General Provider Information

NPI Number : 1669293916
Entity Type Code : Individual
Provider Name (Legal Business Name) : KIMBERLY ANNE SLOAN PMHNP
Provider Business Mailing Address
First Line : 5420 LUCKNOW DR
Second Line :
City : CLAY
State : NY
Zip : 13041-9709
Country : US
Telephone Number : 315-256-8410
Fax Number : 315-291-6601
Provider Business Practice Location Address
First Line : 650 STATE ST
Second Line :
City : WATERTOWN
State : NY
Zip : 13601-2839
Country : US
Telephone Number : 315-755-1251
Fax Number : 315-291-6601
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/21/2024
Last Update Date : 01/08/2026

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1225696743 — AMANDA FROSTAD LCSW
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1649818568 — KRISTINA LYNN MANCHESTER LMSW
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Directions to “ KIMBERLY ANNE SLOAN PMHNP” Practice Location

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