Provider Demographics
NPI:1861697153
Name:HEFFERNAN, KELLY K (FNP)
Entity type:Individual
Prefix:MS
First Name:KELLY
Middle Name:K
Last Name:HEFFERNAN
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 1:9 RIDGEFIELD WAY
Mailing Address - Street 2:
Mailing Address - City:WATERVLIET
Mailing Address - State:NY
Mailing Address - Zip Code:12189-1667
Mailing Address - Country:US
Mailing Address - Phone:518-273-0458
Mailing Address - Fax:518-220-9400
Practice Address - Street 1:624 MCCLELLAN ST
Practice Address - Street 2:SUITE 203 FOX AND SCHINGO PLASTIC SURGERY
Practice Address - City:SCHENECTADY
Practice Address - State:NY
Practice Address - Zip Code:12304-1020
Practice Address - Country:US
Practice Address - Phone:518-346-2358
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF333933363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily