Provider Demographics
NPI:1033092788
Name:CARRUTHERS, KYMBERLYNN
Entity type:Individual
Prefix:
First Name:KYMBERLYNN
Middle Name:
Last Name:CARRUTHERS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1116 BAY 32ND PL
Mailing Address - Street 2:
Mailing Address - City:FAR ROCKAWAY
Mailing Address - State:NY
Mailing Address - Zip Code:11691-1720
Mailing Address - Country:US
Mailing Address - Phone:201-397-0688
Mailing Address - Fax:
Practice Address - Street 1:1116 BAY 32ND PLACE
Practice Address - Street 2:2ND FLOOR
Practice Address - City:QUEENS
Practice Address - State:NY
Practice Address - Zip Code:11691
Practice Address - Country:US
Practice Address - Phone:201-397-0688
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-29
Last Update Date:2025-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY788245163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool