Provider Demographics
NPI:1861591497
Name:CREGAN, KATHLEEN ANN (FNP)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:ANN
Last Name:CREGAN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:346 GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:NY
Mailing Address - Zip Code:13790-2558
Mailing Address - Country:US
Mailing Address - Phone:607-719-8156
Mailing Address - Fax:607-729-3982
Practice Address - Street 1:4417 VESTAL PARKWAY EAST
Practice Address - Street 2:SUITE 200
Practice Address - City:VESTAL
Practice Address - State:NY
Practice Address - Zip Code:13950-3556
Practice Address - Country:US
Practice Address - Phone:607-797-1251
Practice Address - Fax:607-729-4393
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2012-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY330850363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03142692Medicaid
NYJ400060611Medicare PIN