Provider Demographics
NPI:1336921634
Name:FOLEY MCCLINTOCK, KIM MARIE (RN)
Entity type:Individual
Prefix:
First Name:KIM
Middle Name:MARIE
Last Name:FOLEY MCCLINTOCK
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:KIM
Other - Middle Name:MARIE
Other - Last Name:FOLEY MCCLINTOCK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RN
Mailing Address - Street 1:100 LORALEE DR
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12205-2223
Mailing Address - Country:US
Mailing Address - Phone:518-456-2608
Mailing Address - Fax:855-298-5312
Practice Address - Street 1:100 LORALEE DR
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12205-2223
Practice Address - Country:US
Practice Address - Phone:518-456-2608
Practice Address - Fax:855-298-5312
Is Sole Proprietor?:No
Enumeration Date:2023-10-20
Last Update Date:2023-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY483581163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice