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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