Organization
KAG PROFESSIONAL NURSE PRACTITIONER IN ADULT HEALTH PLLC
Active
Organization
KAG PROFESSIONAL NURSE PRACTITIONER IN ADULT HEALTH PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KELLY ANN GODBERSON NP (NURSE PRACTITIONER)
(631) 872-2995
Entity
Organization
Contact information
Practice address
3115 HORSEBLOCK RD, MEDFORD, NY 11763-2526
(631) 872-2995
Mailing address
32 MARLIN RD, CENTEREACH, NY 11720-3012
(631) 872-2995
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
—
—
Other
Enumeration date
05/17/2019
Last updated
10/24/2022
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