Provider Demographics
NPI:1861095259
Name:MCCALPINE, KIMBERLY O'SHEA (LPN, PBT, TRN)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:O'SHEA
Last Name:MCCALPINE
Suffix:
Gender:F
Credentials:LPN, PBT, TRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:143 PENNSYLVANIA AVE
Mailing Address - Street 2:
Mailing Address - City:ROOSEVELT
Mailing Address - State:NY
Mailing Address - Zip Code:11575-1728
Mailing Address - Country:US
Mailing Address - Phone:516-467-6324
Mailing Address - Fax:
Practice Address - Street 1:143 PENNSYLVANIA AVE
Practice Address - Street 2:
Practice Address - City:ROOSEVELT
Practice Address - State:NY
Practice Address - Zip Code:11575-1728
Practice Address - Country:US
Practice Address - Phone:516-467-6324
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-18
Last Update Date:2020-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY338526164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse