Basic Information
| Provider Information | |||||||||
| NPI: | 1306837745 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DEVLIN | ||||||||
| FirstName: | KERIN | ||||||||
| MiddleName: | MCCARTHY | ||||||||
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| Credential: | FNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 100 PARK STREET | ||||||||
| Address2: | GLENS FALLS HOSPITAL - CREDENTIALING | ||||||||
| City: | GLENS FALLS | ||||||||
| State: | NY | ||||||||
| PostalCode: | 12801 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5189265924 | ||||||||
| FaxNumber: | 5189266983 | ||||||||
| Practice Location | |||||||||
| Address1: | 65 POULTNEY ST | ||||||||
| Address2: | WHITEHALL FAMILY MEDICINE | ||||||||
| City: | WHITEHALL | ||||||||
| State: | NY | ||||||||
| PostalCode: | 12887 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5184992444 | ||||||||
| FaxNumber: | 5184990317 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/03/2005 | ||||||||
| LastUpdateDate: | 09/03/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/03/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | F331060 | NY | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | 02251756 | 05 | NY | MEDICAID | P00092388 | 01 | NY | RR MEDICARE | OTHER |