Provider Demographics
NPI:1811420979
Name:KOONCE, KATHRYN (RN)
Entity type:Individual
Prefix:MRS
First Name:KATHRYN
Middle Name:
Last Name:KOONCE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3992 NY 2
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:NY
Mailing Address - Zip Code:12180-9022
Mailing Address - Country:US
Mailing Address - Phone:518-279-3888
Mailing Address - Fax:518-279-3888
Practice Address - Street 1:3992 NY 2
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:NY
Practice Address - Zip Code:12180-9022
Practice Address - Country:US
Practice Address - Phone:518-279-3888
Practice Address - Fax:518-279-3888
Is Sole Proprietor?:No
Enumeration Date:2017-04-06
Last Update Date:2017-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY648294163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse