Provider Demographics
NPI:1932999307
Name:BEAUDRY, KAELA (RN)
Entity type:Individual
Prefix:
First Name:KAELA
Middle Name:
Last Name:BEAUDRY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:KAELA
Other - Middle Name:
Other - Last Name:KILMARTIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:4141 BIRCHWOOD DR N
Mailing Address - Street 2:
Mailing Address - City:LIVERPOOL
Mailing Address - State:NY
Mailing Address - Zip Code:13090-2101
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4141 BIRCHWOOD DR N
Practice Address - Street 2:
Practice Address - City:LIVERPOOL
Practice Address - State:NY
Practice Address - Zip Code:13090-2101
Practice Address - Country:US
Practice Address - Phone:315-794-8410
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-08
Last Update Date:2025-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY738464163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse