Individual
KELLY WILMARTH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
C-FNP
Contact information
Practice address
401 MAIN ST STE 1, JOHNSON CITY, NY 13790-2065
(607) 754-9870
(607) 785-9862
Mailing address
401 MAIN ST STE 1, JOHNSON CITY, NY 13790-2065
(607) 754-9870
(607) 785-9862
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
338979
NY
Other
Enumeration date
07/24/2014
Last updated
09/17/2021
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