DAVID A KIBBY (NPI# 1649481409) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1649481409 |
| Entity Type | Individual |
| Full Name | DAVID A KIBBY |
| Credential | PA |
| Practice Address |
5719 Widewaters Pkwy Syracuse NY 13214-1985 |
| Practice Telephone | 3152513100 |
| Practice Fax Number | 3154499923 |
| Mailing Telephone | 3152513100 |
| Mailing Fax Number | 3154499923 |
| Enumeration Date | 2007-05-24 |
| Last Update Date | 2011-11-23 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363A00000X | Physician Assistant | 011985 | NY | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| NY | MEDICARE PTAN# | J400002999 | 01 |
| NY | 02925964 | 05 |
| Street Address |
5719 WIDEWATERS PKWY |
| City | SYRACUSE |
| State | NY |
| Zip Code | 13214-1985 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1871598805 | Michael T Clarke | Orthopaedic Surgery | 5719 Widewaters Pkwy, Syracuse, NY 13214-1880 | 2005-06-16 |
| 1700486065 | Heather M. Stamour | Nurse Practitioner | 5719 Widewaters Pkwy, Syracuse, NY 13214-1985 | 2020-10-27 |
| 1962062364 | Onondaga Orthopedics LLP | Durable Medical Equipment & Medical Supplies | 5719 Widewaters Pkwy, Syracuse, NY 13214-1985 | 2019-06-18 |
| 1548711583 | Laura Yasuko Goodwell-velez | Specialist/Technologist | 5719 Widewaters Pkwy, Syracuse, NY 13214-1985 | 2016-10-14 |
| 1811448855 | Laurance Goodwin IIi | Specialist/Technologist | 5719 Widewaters Pkwy, Syracuse, NY 13214-1985 | 2016-10-14 |
| 1326486754 | Nicole I. Jones | Physician Assistant | 5719 Widewaters Pkwy, Syracuse, NY 13214-1985 | 2013-06-07 |
| 1821330176 | Anthony M Orio | Orthopaedic Surgery | 5719 Widewaters Pkwy, Syracuse, NY 13214-1985 | 2013-03-25 |
| 1790036697 | Marvin Balmir | Physician Assistant | 5719 Widewaters Pkwy, Syracuse, NY 13214-1985 | 2012-10-02 |
| 1295093763 | Cassandra Riggs | Orthopaedic Surgery | 5719 Widewaters Pkwy, Syracuse, NY 13214 | 2012-05-02 |
| 1275845760 | Melissa A Cullinan | Physician Assistant | 5719 Widewaters Pkwy, Syracuse, NY 13214-1877 | 2010-07-13 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1881108983 | Nathan Fowler | Dentist | 3469 Erie Blvd E # 3a, Syracuse, NY 13214 | 2017-11-28 |
| 1841716875 | Walgreen Co | Durable Medical Equipment & Medical Supplies | 3649 Erie Blvd E Ste 215b, Syracuse, NY 13214 | 2017-08-22 |
| 1124568993 | Jose Alvarez | Dentist | 3425 Erie Blvd E Ste 1, De Witt, NY 13214 | 2017-02-27 |
| 1205258365 | Margaret Miller | Social Worker | 4101 E. Genesee St, Syracuse, NY 13214 | 2014-01-09 |
| 1124367669 | Marni Marie Millet | Counselor | 4309 E Genesee St Ste 4, Syracuse, NY 13214 | 2013-02-04 |
| 1477817401 | Runa Acharya | Internal Medicine | 3229 East Genesee St, Syracuse, NY 13214 | 2012-06-25 |
| 1487949913 | Angela Patricia Mojica Sanabria | Pediatrics | 3229 East Genesee St Ste 1, Syracuse, NY 13214 | 2011-06-13 |
| 1346530169 | Affinity Rehabilitation LLP | Clinic/Center | 18 Arbor Lane, Dewitt, NY 13214 | 2011-04-13 |
| 1003105768 | David William Hansen | Pediatrics | 3229 E. Genesee St, Suite 1, Syracuse, NY 13214 | 2011-04-04 |
| 1558676411 | Jamesville-dewitt Central School District | Local Education Agency (LEA) | Edinger Drive, Dewitt, NY 13214 | 2010-08-16 |
| Find all providers in zip 13214 | ||||
| Taxonomy Code | 363A00000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1679133359 | Nicole Raczkowski | Physician Assistant | 121 Gertrude St Apt 1, Syracuse, NY 13203-2441 | 2019-06-16 |
| 1710544218 | Silver Lining Medical & Consulting, LLC | Physician Assistant | 2876 S 1200 W, Syracuse, UT 84075-8653 | 2019-05-21 |
| 1942779871 | Elizabeth Eileen Chaskey | Physician Assistant | 103 Lockwood Rd, Syracuse, NY 13214-2032 | 2018-11-20 |
| 1316452964 | Merrick Lynne Doody | Physician Assistant | 104 Union Ave # 806-807, Syracuse, NY 13203-1843 | 2017-12-05 |
| 1831640440 | Elana Radin | Physician Assistant | 4440 Ashfield Ter, Syracuse, NY 13215-2463 | 2016-10-18 |
| 1659820835 | Eric Lance Brandenburg | Physician Assistant | 1120 Westmoreland Ave, Syracuse, NY 13210-3161 | 2016-09-28 |
| 1831555747 | Ward Irvin Jr. | Physician Assistant | 104 Union Ave Ste 908, Syracuse, NY 13203-1845 | 2016-01-07 |
| 1497158158 | Jill J Weatherly | Physician Assistant | 4900 Broad Rd Ofc, Syracuse, NY 13215-2265 | 2014-10-08 |
| 1144563800 | Melissa Anne Harnsberger | Physician Assistant | 1000 E Genesee St Ste 300, Syracuse, NY 13210-1853 | 2013-04-01 |
| 1306184403 | Adriane Nicole Arnold | Physician Assistant | 317 S Clinton St, Apt 4d, Syracuse, NY 13202-1216 | 2013-01-23 |
| Find all providers in SYRACUSE | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.