Provider Demographics
NPI:1194890384
Name:CALLAHAN, KAY LORRAINE (RN FNP)
Entity type:Individual
Prefix:
First Name:KAY
Middle Name:LORRAINE
Last Name:CALLAHAN
Suffix:
Gender:F
Credentials:RN FNP
Other - Prefix:
Other - First Name:KAY
Other - Middle Name:KRISE
Other - Last Name:CALLAHAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:8100 OSWEGO ROAD
Mailing Address - Street 2:SUITE 220
Mailing Address - City:LIVERPOOL
Mailing Address - State:NY
Mailing Address - Zip Code:13090
Mailing Address - Country:US
Mailing Address - Phone:315-652-6551
Mailing Address - Fax:315-652-9698
Practice Address - Street 1:8100 OSWEGO ROAD
Practice Address - Street 2:SUITE 220
Practice Address - City:LIVERPOOL
Practice Address - State:NY
Practice Address - Zip Code:13090
Practice Address - Country:US
Practice Address - Phone:315-652-6551
Practice Address - Fax:315-652-9698
Is Sole Proprietor?:No
Enumeration Date:2006-11-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF330868363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
324024OtherMVP HEALTHCARE
000920681001OtherHEALTHNOW