CHEYENNE MACKENZIE DOUGLAS (NPI# 1558886457) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1558886457 |
| Entity Type | Individual |
| Full Name | CHEYENNE MACKENZIE DOUGLAS |
| Other Name | CHEYENNE-AUTUMN MACKENZIE DOUGLAS |
| Credential | MSN, RN, CPNP-PC |
| Practice Address |
7b Johnson Rd Latham NY 12110-3003 |
| Mailing Address |
711 Troy Schenectady Rd Ste 203 Latham NY 12110-2461 |
| Practice Telephone | 5187827733 |
| Practice Fax Number | 5187820800 |
| Mailing Telephone | 5187823700 |
| Mailing Fax Number | 5187823799 |
| Enumeration Date | 2017-08-11 |
| Last Update Date | 2019-01-28 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363LP0200X |
Nurse Practitioner Specialization: Pediatrics |
382889 | NY | Physician Assistants & Advanced Practice Nursing Providers |
| N | 363LP0200X |
Nurse Practitioner Specialization: Pediatrics |
7144 | CT | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| NY | 05384905 | 05 |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 282 Washington St, Hartford, CT 061063322 | 8605459000 |
| Street Address |
7B JOHNSON RD |
| City | LATHAM |
| State | NY |
| Zip Code | 12110-3003 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1992774780 | Catherine Canary | Pediatrics | 7b Johnson Rd, Latham, NY 12110-3003 | 2006-03-15 |
| 1063987915 | April Marie St. Peter | Nurse Practitioner | 7b Johnson Rd, Latham, NY 12110-3003 | 2018-10-08 |
| 1811478191 | Matthew Thomas Hickling | Nurse Practitioner | 7b Johnson Rd, Latham, NY 12110-3003 | 2018-08-24 |
| 1831615772 | Maude A Kaye | Nurse Practitioner | 7b Johnson Rd, Latham, NY 12110-3003 | 2017-08-22 |
| 1922451863 | Jillian Elyse Herrington | Nurse Practitioner | 7b Johnson Rd, Latham, NY 12110-3003 | 2016-07-15 |
| 1164704136 | Community Care Physicians, PC | Pediatrics | 7b Johnson Rd, Latham, NY 12110-3003 | 2011-09-15 |
| 1962638965 | Daniel Greenblatt | Pediatrics | 7b Johnson Rd, Latham, NY 12110-3003 | 2009-06-04 |
| 1124266606 | Donna Ann Riccio | Specialist | 7b Johnson Rd, Latham, NY 12110-3003 | 2009-01-22 |
| 1831337310 | Linda Lee Gaidusek | Registered Nurse | 7b Johnson Rd, Latham, NY 12110-3003 | 2009-01-22 |
| 1538311782 | Susan J Hull | Specialist | 7b Johnson Rd, Latham, NY 12110-3003 | 2008-10-21 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1154963973 | Bayley Archinal | Physical Therapist | 711 Troy-schenectady Road, Ste 216, Latham, NY 12110 | 2019-10-14 |
| 1114410701 | Kimberly A. Hostig Licensed Clinical Social Worker Pllc | Clinic/Center | 8 Stanley Cir Ste 11, Latham, NY 12110 | 2018-06-08 |
| 1710477260 | Colleen Phillips | Physical Therapist | 711 Troy Schenectady Rd Ste 216, Latham, NY 12110 | 2018-05-10 |
| 1528574779 | Deborah Cannon | Specialist | 33c Waterford Avenue East, Latham, NY 12110 | 2017-12-26 |
| 1730600149 | Michael Navarrete | Dentist | 231 Wade Road Ext Unit 101, Latham, NY 12110 | 2017-07-06 |
| 1316499452 | Colonie Asc LLC | Clinic/Center | 207 Troy-schenectady Rd, Colonie, NY 12110 | 2016-10-25 |
| 1720539950 | Tania M Durante | Pharmacist | 1057 Troy-schenectady Rd, Latham, NY 12110 | 2016-10-24 |
| 1417344987 | New York Epilepsy Medicine, PC | Clinic/Center | 3 Lear Jet Ln Ste 203, Latham, NY 12110 | 2015-04-22 |
| 1346664752 | Lauren Gannon | Registered Nurse | 95 Forts Ferry Road, Latham, NY 12110 | 2014-02-06 |
| 1649522756 | Natasha Kapsaroff-ruiz | Nurse Practitioner | 654 Watervliet Shaker Rd, Latham, NY 12110 | 2012-10-12 |
| Find all providers in zip 12110 | ||||
| Taxonomy Code | 363LP0200X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Pediatrics |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1942858477 | Sarah Elizabeth Aluck | Nurse Practitioner | 711 Troy Schenectady Rd Ste 101, Latham, NY 12110-2468 | 2019-08-28 |
| 1811478191 | Matthew Thomas Hickling | Nurse Practitioner | 7b Johnson Rd, Latham, NY 12110-3003 | 2018-08-24 |
| 1457874547 | Jenna Laine Warner | Nurse Practitioner | 711 Troy Schenectady Rd Ste 101, Latham, NY 12110-2454 | 2017-07-20 |
| 1922451863 | Jillian Elyse Herrington | Nurse Practitioner | 7b Johnson Rd, Latham, NY 12110-3003 | 2016-07-15 |
| 1992187223 | Stephanie Guice | Nurse Practitioner | 10 Century Hill Dr, Latham, NY 12110-2162 | 2015-06-23 |
| 1871756528 | Erin Veenker Larrabee | Nurse Practitioner | 7b Johnson Rd, Latham, NY 12110 | 2008-07-02 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1932709821 | Shu-heng Wang | Nurse Practitioner | 7324 18th Ave, Brooklyn, NY 11204-5678 | 2020-10-29 |
| 1952909012 | Marina Byshovets | Nurse Practitioner | 164 Admiralty Loop, Staten Island, NY 10309-3964 | 2020-10-12 |
| 1700483799 | Dmitry Pediatrics, Pediatric Nurse Practitioner PC | Nurse Practitioner | 10 Shore Blvd Apt 1g, Brooklyn, NY 11235-4022 | 2020-10-03 |
| 1427664572 | Leigh Ann Cohen | Nurse Practitioner | 2 Lincoln Ave Ste 301, Rockville Centre, NY 11570-5775 | 2020-09-23 |
| 1295341436 | Tatiana Margaret Masone | Nurse Practitioner | 3142 Victory Blvd, Staten Island, NY 10314-6717 | 2020-09-22 |
| 1992311567 | Jyneva W Pickel | Nurse Practitioner | 3959 Broadway Rm 722, New York, NY 10032-1559 | 2020-09-19 |
| 1902410186 | Katie Elise Boyd | Nurse Practitioner | 725 Irving Ave Ste 504, Syracuse, NY 13210-1683 | 2020-09-03 |
| 1437763877 | Tiffany Yu | Nurse Practitioner | 1746 W 12th St, Brooklyn, NY 11223-1101 | 2020-09-02 |
| 1134733710 | Khristan Heagle Haller | Nurse Practitioner | 20 Locust Ln, Bronxville, NY 10708-4933 | 2020-09-01 |
| 1831703412 | Marijana Waite | Nurse Practitioner | 6544 Saunders St Apt A7, Rego Park, NY 11374-4209 | 2020-09-01 |
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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.