Individual
KYLIE MAE TAVERNIA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1225 STATE ROUTE 122, CONSTABLE, NY 12926-3006
(518) 651-0487
Mailing address
125 FINNEY BLVD, MALONE, NY 12953-1067
(518) 483-1251
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
376K00000X
Nurse's Aide
—
—
Other
Enumeration date
10/25/2021
Last updated
11/15/2021
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