Provider Demographics
NPI:1144940131
Name:KC HEALTHCARE SERVICES FAMILY HEALTH NURSE PRACTITIONER PLLC
Entity type:Organization
Organization Name:KC HEALTHCARE SERVICES FAMILY HEALTH NURSE PRACTITIONER PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDTAILING SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:
Authorized Official - Last Name:SCOTT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-797-5958
Mailing Address - Street 1:567 MILLER AVE
Mailing Address - Street 2:
Mailing Address - City:FREEPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11520-6310
Mailing Address - Country:US
Mailing Address - Phone:917-548-8917
Mailing Address - Fax:
Practice Address - Street 1:567 MILLER AVE
Practice Address - Street 2:
Practice Address - City:FREEPORT
Practice Address - State:NY
Practice Address - Zip Code:11520-6310
Practice Address - Country:US
Practice Address - Phone:917-548-8917
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-30
Last Update Date:2022-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty