Provider Demographics
NPI:1962908293
Name:KELSTONE, KIMBERLY S (DNP, CNM)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:S
Last Name:KELSTONE
Suffix:
Gender:F
Credentials:DNP, CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:251 SALINA MEADOWS PKWY
Mailing Address - Street 2:STE 100
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13212-4516
Mailing Address - Country:US
Mailing Address - Phone:315-464-2000
Mailing Address - Fax:315-464-2010
Practice Address - Street 1:725 IRVING AVE
Practice Address - Street 2:STE 600
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13210
Practice Address - Country:US
Practice Address - Phone:315-464-5162
Practice Address - Fax:315-464-4613
Is Sole Proprietor?:No
Enumeration Date:2018-04-04
Last Update Date:2022-01-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY001880367A00000X
VA002480175367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY001880OtherNY STATE OFFICE OF THE PROFESSIONS
NY05247618Medicaid
VA0024180175OtherVIRGINIA BOARD OF NURSING