Individual
DESIREE KINNISON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
90 PRESIDENTIAL PLAZA, SYRACUSE, NY 13202
(315) 464-9335
(315) 464-9338
Mailing address
251 SALINA MEADOWS PARKWAY, SUITE 100, SYRACUSE, NY 13212
(315) 464-2000
(315) 464-2010
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
348082
NY
363L00000X
Nurse Practitioner
348082
NY
363LF0000X
Family Nurse Practitioner
Primary
348082
NY
Other
Enumeration date
07/23/2020
Last updated
12/19/2024
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