Individual
KIRA LEE-LIN GRIDLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP-C
Contact information
Practice address
6870 E GENESEE ST, FAYETTEVILLE, NY 13066-1031
(315) 679-4367
(315) 679-4368
Mailing address
109 GENESEE ST, ONEIDA, NY 13421-2703
(315) 231-5530
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
F351912-01
NY
Other
Enumeration date
03/08/2024
Last updated
04/07/2026
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