Basic Information
| Provider Information | |||||||||
| NPI: | 1649623984 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KISE | ||||||||
| FirstName: | MEGHAN | ||||||||
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| Credential: | PNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5010 STATE HIGHWAY 30 | ||||||||
| Address2: | SUITE G02 | ||||||||
| City: | AMSTERDAM | ||||||||
| State: | NY | ||||||||
| PostalCode: | 120107532 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5188420017 | ||||||||
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| Practice Location | |||||||||
| Address1: | 5010 STATE HIGHWAY 30 | ||||||||
| Address2: | SUITE G02 | ||||||||
| City: | AMSTERDAM | ||||||||
| State: | NY | ||||||||
| PostalCode: | 120107532 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5188420017 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/21/2016 | ||||||||
| LastUpdateDate: | 07/21/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LP0200X | 382653 | NY | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Pediatrics |
No ID Information.