KAG PROFESSIONAL NURSE PRACTIONER IN ADULT HEALTH PLLC (NPI# 1295391985) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1295391985 |
| Entity Type | Organization |
| Organization Name | KAG PROFESSIONAL NURSE PRACTIONER IN ADULT HEALTH PLLC |
| Practice Address |
3115 Horseblock Rd Medford NY 11763-2526 |
| Mailing Address |
32 Marlin Rd Centereach NY 11720-3012 |
| Practice Telephone | 6318722995 |
| Mailing Telephone | 6318722995 |
| Enumeration Date | 2019-05-17 |
| Last Update Date | 2019-05-17 |
| Authorized Official Name | KELLY ANN GODBERSON (OWNER) |
| Authorized Official Telephone | 6318722995 |
| Authorized Official Credential | NURSE PRACTIONER |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363LA2200X |
Nurse Practitioner Specialization: Adult Health |
Physician Assistants & Advanced Practice Nursing Providers |
| Street Address |
3115 HORSEBLOCK RD |
| City | MEDFORD |
| State | NY |
| Zip Code | 11763-2526 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1679563464 | Nursing Care Center At Medford Inc | Skilled Nursing Facility | 3115 Horseblock Rd, Medford, NY 11763 | 2005-10-24 |
| 1053833962 | Kelly Ann Godberson | Nurse Practitioner | 3115 Horseblock Rd, Medford, NY 11763-2526 | 2017-07-12 |
| 1104076892 | Michelle Bennett | Licensed Practical Nurse | 3115 Horseblock Rd, Medford, NY 11763-2526 | 2008-09-30 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1316572027 | Rebecca Molino | Specialist | 9, 3251 Ny-112 #2, Medford, NY 11763 | 2020-03-03 |
| 1295203677 | Hajar Taman | Pharmacist | 2975 Horseblock Road, Medford, NY 11763 | 2018-11-05 |
| 1265917041 | Bay Taxi Inc | Taxi | 36/94 Horseblock Rd, Medford, NY 11763 | 2018-09-27 |
| 1184108383 | Bay Taxi Inc | Taxi | 36/94 Horsblock Road, Medford, NY 11763 | 2018-09-24 |
| 1215419650 | Megan Bell | Speech-Language Pathologist | 135 Buffalo Avenue, Medford, NY 11763 | 2018-09-01 |
| 1922592906 | Elizabeth L Oakley | Specialist | 1 Sprat St, Medford, NY 11763 | 2018-06-21 |
| 1609383389 | Federation of Organizations for The New York State Mentally Disabled | Clinic/Center | 3390 Route 112 Ste B, Medford, NY 11763 | 2018-01-04 |
| 1497109607 | Tabitha Aitken | Massage Therapist | 28 Masem Ct, Medford, NY 11763 | 2016-04-14 |
| 1518326685 | Betty Velez | Specialist | 21 Red Pine Rd, Medford, NY 11763 | 2016-02-18 |
| 1134527054 | Angelo L D'esposito | Social Worker | 77 Robinson Ave, Medford, NY 11763 | 2014-12-09 |
| Find all providers in zip 11763 | ||||
| Taxonomy Code | 363LA2200X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Adult Health |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1487216743 | Lisa Susan Williams | Nurse Practitioner | 76 Southaven Ave Ste 5, Medford, NY 11763-3745 | 2019-07-07 |
| 1003839424 | Christine Ann Stanek | Nurse Practitioner | 2859 State Street, Suite 101, Medford, OR 97504 | 2006-07-26 |
| 1114997244 | Eileen Weldon Stiles | Nurse Practitioner | 520 Medical Center Drive, Suite 201, Medford, OR 97504-4434 | 2006-01-23 |
| 1134129133 | Barbara Anne Stewart | Nurse Practitioner | 2960 Doctors Park Dr, Medford, OR 97504-8127 | 2005-08-01 |
| 1013458405 | Elysian Health | Nurse Practitioner | 835 Crater Lake Ave, Medford, OR 97504-6505 | 2017-03-17 |
| 1801335336 | Julia Ann Smith | Nurse Practitioner | 811 W Broadway Ave, Medford, WI 54451-1307 | 2017-02-16 |
| 1528506334 | Rebecca Rampton | Nurse Practitioner | 3617 S Pacific Hwy, Medford, OR 97501-8957 | 2017-02-01 |
| 1700238623 | Courtney Nicholas | Nurse Practitioner | 1723 N Ocean Ave, Medford, NY 11763-2687 | 2016-07-02 |
| 1871983353 | Nancy Obispo | Nurse Practitioner | 555 Black Oak Drive, Suite 300, Medford, OR 97504-8491 | 2015-02-04 |
| 1881006997 | Erin Marie Dittmer | Nurse Practitioner | 920 Royal Ave, Medford, OR 97504-6169 | 2014-05-22 |
| Find all providers in MEDFORD | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.