1. Home
  2. Directory
  3. New York
  4. Medford
  5. Nurse Practitioner
  6. NPI Profile

KAG PROFESSIONAL NURSE PRACTITIONER IN ADULT HEALTH PLLC
NPI 1295391985
Nurse Practitioner - Adult Health in Medford, NY

Active since May 17, 2019
3115 HORSEBLOCK RD, MEDFORD, NY 11763(631) 872-2995 Get Directions Write a Review

NPPES record last updated: October 24, 2022. Verified against the NPPES registry weekly; last sync: August 02, 2026.

Record update history: Oct 24, 2022, May 17, 2019 (2 updates tracked since 2019).

About Kag Professional Nurse Practitioner In Adult Health Pllc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

KAG PROFESSIONAL NURSE PRACTITIONER IN ADULT HEALTH PLLC (NPI 1295391985) is a healthcare organization registered as an adult health in Medford, New York and active in the NPI registry since May 2019. The organization lists Kelly Ann Godberson, Nurse Practitioner, as its authorized official.

NPPES Registry Identity

NPI1295391985
Entity TypeOrganization
Primary Taxonomy363LA2200X
Legal Business NameKAG PROFESSIONAL NURSE PRACTITIONER IN ADULT HEALTH PLLC
Location Address3115 HORSEBLOCK RDMedford, NY 11763-2526
Mailing Address32 Marlin RdCentereach, NY 11720-3012 · (631) 872-2995
Phone(631) 872-2995
Organization SubpartNo
Authorized OfficialKelly Ann GodbersonNurse Practitioner · (631) 872-2995
Enumeration DateMay 17, 2019
Last NPPES UpdateOctober 24, 20222 updates tracked since enumeration
NPPES CertifiedJuly 14, 2022
✔ NPI 1295391985 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyNurse Practitioner · Adult HealthPhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363LA2200X
3115 HORSEBLOCK RD, Medford, NY 11763
Open in Google Maps ↗

Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

Other Providers at the Same Location NPPES 6

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

MRS. KELLY ANN GODBERSON NP
Nurse Practitioner
3115 HORSEBLOCK RD
MEDFORD, NY 11763
Suffolk County (631) 730-3000
SHANNON THAYER MS, CCC-SLP
Speech-Language Pathologist
3115 HORSEBLOCK RD
MEDFORD, NY 11763
Suffolk County (631) 730-3039
MRS. MICHELLE BENNETT L.P.N
Licensed Practical Nurse
3115 HORSEBLOCK RD
MEDFORD, NY 11763
Suffolk County (631) 730-3000
DR. RAHUL GLADWIN MD
Internal Medicine
3115 HORSEBLOCK RD
MEDFORD, NY 11763
Suffolk County (631) 730-3000
SAMANTHA GLEESON RN
Registered Nurse
3115 HORSEBLOCK RD
MEDFORD, NY 11763
Suffolk County (631) 730-3000
NURSING CARE CENTER AT MEDFORD INC
Skilled Nursing Facility
3115 HORSEBLOCK RD
MEDFORD, NY 11763
Suffolk County (631) 730-3016

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Kag Professional Nurse Practitioner In Adult Health PLLC's NPI number?

The NPI number for Kag Professional Nurse Practitioner In Adult Health PLLC is 1295391985. It was assigned to this organization in the NPPES registry on May 17, 2019.

Where is Kag Professional Nurse Practitioner In Adult Health PLLC located?

Kag Professional Nurse Practitioner In Adult Health PLLC is located at 3115 Horseblock Rd, Medford, NY 11763. The listed phone number is (631) 872-2995.

What is Kag Professional Nurse Practitioner In Adult Health PLLC's specialty?

The primary specialty registered for this NPI is Nurse Practitioner, specializing in Adult Health, with taxonomy code 363LA2200X.

When was this NPI record last updated?

The NPPES record for Kag Professional Nurse Practitioner In Adult Health PLLC was last updated on October 24, 2022. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 3 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.