Individual
KIMBERLY MAE CARREON CARILLO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
622 W 168TH ST FL 14, NEW YORK, NY 10032-3720
(212) 305-0914
Mailing address
295 ROUTE 340, SPARKILL, NY 10976-1205
(845) 596-1369
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
F308369-1
NY
363LA2200X
Adult Health Nurse Practitioner
Primary
308369
NY
Other
Enumeration date
12/16/2018
Last updated
11/24/2025
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