Provider Demographics
NPI:1811466048
Name:LEROY, KAYLEE S (RN)
Entity type:Individual
Prefix:
First Name:KAYLEE
Middle Name:S
Last Name:LEROY
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 1:118 WHITTIER AVE
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13204-2637
Mailing Address - Country:US
Mailing Address - Phone:315-751-7868
Mailing Address - Fax:
Practice Address - Street 1:4240 LAFAYETTE RD
Practice Address - Street 2:
Practice Address - City:JAMESVILLE
Practice Address - State:NY
Practice Address - Zip Code:13078-9770
Practice Address - Country:US
Practice Address - Phone:315-492-4233
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-16
Last Update Date:2018-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY752371-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse