Provider Demographics
NPI:1194772012
Name:COSGROVE-DRURY, KATHLEEN F (NP)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:F
Last Name:COSGROVE-DRURY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 IVY GREEN CT
Mailing Address - Street 2:
Mailing Address - City:AMHERST
Mailing Address - State:NY
Mailing Address - Zip Code:14226-3525
Mailing Address - Country:US
Mailing Address - Phone:716-832-7116
Mailing Address - Fax:
Practice Address - Street 1:19 IVY GREEN CT
Practice Address - Street 2:
Practice Address - City:AMHERST
Practice Address - State:NY
Practice Address - Zip Code:14226-3525
Practice Address - Country:US
Practice Address - Phone:716-832-7116
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-27
Last Update Date:2010-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF300783-1363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP72509Medicare UPIN