Provider Demographics
NPI:1861967515
Name:ROWE, KERRIN ELIZABETH (AGPCNP)
Entity type:Individual
Prefix:
First Name:KERRIN
Middle Name:ELIZABETH
Last Name:ROWE
Suffix:
Gender:F
Credentials:AGPCNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1320 STONY BROOK RD STE 100
Mailing Address - Street 2:
Mailing Address - City:STONY BROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11790-2222
Mailing Address - Country:US
Mailing Address - Phone:631-941-2273
Mailing Address - Fax:516-706-2150
Practice Address - Street 1:1320 STONY BROOK RD STE 100
Practice Address - Street 2:
Practice Address - City:STONY BROOK
Practice Address - State:NY
Practice Address - Zip Code:11790-2222
Practice Address - Country:US
Practice Address - Phone:631-941-2273
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-09
Last Update Date:2019-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY308858363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health