# KMC NURSE PRACTITIONER IN ADULT HEALTH PLLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1295570034
- **Authorized official:** KYM CANNIZZARO (OWNER/NP)
- **Authorized official phone:** (716) 759-4938

## Contact information

- **Practice address:** 9097 MAIN ST, CLARENCE, NY 14031-1965
- **Practice address phone:** (716) 759-4938
- **Practice address fax:** (716) 759-4939
- **Mailing address:** 9097 MAIN ST, CLARENCE, NY 14031-1965
- **Mailing address phone:** (716) 759-4938
- **Mailing address fax:** (716) 759-4939

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363LA2200X | Adult Health Nurse Practitioner | — | NULL | Yes |
| 363LA2200X | Adult Health Nurse Practitioner | — | — | Yes |

## Other

- **Enumeration date:** 06/25/2024
- **Last updated:** 07/11/2024