Basic Information
| Provider Information | |||||||||
| NPI: | 1114698321 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | NORAGONG | ||||||||
| FirstName: | KIMBERLY | ||||||||
| MiddleName: | ANN | ||||||||
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| Credential: | NP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 15365 RAMSEY SHRS E | ||||||||
| Address2: | |||||||||
| City: | ADAMS | ||||||||
| State: | NY | ||||||||
| PostalCode: | 136052336 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5857321438 | ||||||||
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| Practice Location | |||||||||
| Address1: | 238 ARSENAL ST | ||||||||
| Address2: | |||||||||
| City: | WATERTOWN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 136012504 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3157829450 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/27/2021 | ||||||||
| LastUpdateDate: | 09/27/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/16/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 348536 | NY | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.