Provider Demographics
NPI:1386697464
Name:DEMPSEY, KRISTIN M (MS, FNP-C)
Entity type:Individual
Prefix:MRS
First Name:KRISTIN
Middle Name:M
Last Name:DEMPSEY
Suffix:
Gender:F
Credentials:MS, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 JERVIS AVE
Mailing Address - Street 2:
Mailing Address - City:ROME
Mailing Address - State:NY
Mailing Address - Zip Code:13440-2335
Mailing Address - Country:US
Mailing Address - Phone:315-877-6286
Mailing Address - Fax:
Practice Address - Street 1:110 UTICA ROAD
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:NY
Practice Address - Zip Code:13323
Practice Address - Country:US
Practice Address - Phone:315-877-6286
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF-331287363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
P21591Medicare UPIN
CC3857Medicare ID - Type Unspecified