Basic Information
Provider Information
NPI: 1053953471
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: PRESCOTT
FirstName: BARBARA
MiddleName: JEAN
NamePrefix:  
NameSuffix:  
Credential: FNP
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 711 TROY SCHENECTADY RD STE 203
Address2:  
City: LATHAM
State: NY
PostalCode: 121102461
CountryCode: US
TelephoneNumber: 5187823700
FaxNumber: 5187823799
Practice Location
Address1: 711 TROY SCHENECTADY RD STE 104
Address2:  
City: LATHAM
State: NY
PostalCode: 121102454
CountryCode: US
TelephoneNumber: 5187833110
FaxNumber: 5187838510
Other Information
ProviderEnumerationDate: 10/17/2019
LastUpdateDate: 10/31/2019
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
163W00000X703849NYN Nursing Service ProvidersRegistered Nurse 
363LF0000X345204NYY Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily

No ID Information.


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