Provider Demographics
NPI:1700322039
Name:CADY, KIMBERLY
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:
Last Name:CADY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:898 KELLY RD
Mailing Address - Street 2:
Mailing Address - City:REXVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14877-9778
Mailing Address - Country:US
Mailing Address - Phone:607-368-4274
Mailing Address - Fax:
Practice Address - Street 1:898 KELLY RD
Practice Address - Street 2:
Practice Address - City:REXVILLE
Practice Address - State:NY
Practice Address - Zip Code:14877-9778
Practice Address - Country:US
Practice Address - Phone:607-368-4274
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-10
Last Update Date:2017-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY722160163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse