Provider Demographics
NPI:1710357959
Name:FEERICK, KAITLYN JEAN (NP)
Entity type:Individual
Prefix:
First Name:KAITLYN
Middle Name:JEAN
Last Name:FEERICK
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1111 MARCUS AVE
Mailing Address - Street 2:
Mailing Address - City:NEW HYDE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11042-1221
Mailing Address - Country:US
Mailing Address - Phone:631-835-1358
Mailing Address - Fax:
Practice Address - Street 1:470 N ERIE AVE
Practice Address - Street 2:
Practice Address - City:LINDENHURST
Practice Address - State:NY
Practice Address - Zip Code:11757-3439
Practice Address - Country:US
Practice Address - Phone:631-835-1358
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-30
Last Update Date:2025-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY705859251E00000X
NYF383730-01363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No251E00000XAgenciesHome Health