Provider Demographics
NPI:1962141051
Name:KLING, KENNETH BRIAN (NP)
Entity type:Individual
Prefix:MR
First Name:KENNETH
Middle Name:BRIAN
Last Name:KLING
Suffix:
Gender:M
Credentials:NP
Other - Prefix:MR
Other - First Name:BRIAN
Other - Middle Name:KENNETH
Other - Last Name:KLING
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:5528 ROCKHAMPTON PATH
Mailing Address - Street 2:
Mailing Address - City:CLAY
Mailing Address - State:NY
Mailing Address - Zip Code:13041-6907
Mailing Address - Country:US
Mailing Address - Phone:315-289-9668
Mailing Address - Fax:
Practice Address - Street 1:750 E ADAMS ST
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13210-1834
Practice Address - Country:US
Practice Address - Phone:315-464-5540
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-27
Last Update Date:2022-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY345947363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner