Provider Demographics
NPI:1487731840
Name:AVILA, KATHLEEN A (ANP RN)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:A
Last Name:AVILA
Suffix:
Gender:F
Credentials:ANP RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 WENDY RD
Mailing Address - Street 2:
Mailing Address - City:WAPPINGERS FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:12590-2008
Mailing Address - Country:US
Mailing Address - Phone:845-297-1804
Mailing Address - Fax:
Practice Address - Street 1:1400 PELHAM PKWY S
Practice Address - Street 2:B #1 ROOM 4W6 JACOBI MEDICAL CENTER
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10461-1138
Practice Address - Country:US
Practice Address - Phone:718-918-6036
Practice Address - Fax:718-918-7701
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2010-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY232380163W00000X
NYF301174363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
S48210Medicare UPIN
NY007881Medicare ID - Type Unspecified