Provider Demographics
NPI:1467670174
Name:KUYKENDALL, CAROLYN MOBLEY (APRN, FNP-C, CPNP-AC)
Entity type:Individual
Prefix:MRS
First Name:CAROLYN
Middle Name:MOBLEY
Last Name:KUYKENDALL
Suffix:
Gender:F
Credentials:APRN, FNP-C, CPNP-AC
Other - Prefix:MS
Other - First Name:CAROLYN
Other - Middle Name:ELIZABETH
Other - Last Name:MOBLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP-C, CPNP-AC
Mailing Address - Street 1:605 W 42ND ST APT 26R
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10036-2080
Mailing Address - Country:US
Mailing Address - Phone:214-505-0363
Mailing Address - Fax:
Practice Address - Street 1:2715 30TH AVE
Practice Address - Street 2:
Practice Address - City:ASTORIA
Practice Address - State:NY
Practice Address - Zip Code:11102-2445
Practice Address - Country:US
Practice Address - Phone:718-685-2300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-20
Last Update Date:2024-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP136125363L00000X, 363LF0000X, 363LP0222X
NYF346211363LF0000X, 363L00000X
NYF383143363LP0222X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
No363LP0222XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics, Critical CareGroup - Multi-Specialty