Provider Demographics
NPI:1174131189
Name:FARQUHARSON, KIMBERLY LAUREN ADRIA (RN)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:LAUREN ADRIA
Last Name:FARQUHARSON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MS
Other - First Name:KIMBERLY
Other - Middle Name:LAUREN ADRIA
Other - Last Name:HENRY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPN
Mailing Address - Street 1:6 MARTIN LN
Mailing Address - Street 2:
Mailing Address - City:WESTBURY
Mailing Address - State:NY
Mailing Address - Zip Code:11590-6323
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:263 BLUE POINT AVE # 263
Practice Address - Street 2:
Practice Address - City:BLUE POINT
Practice Address - State:NY
Practice Address - Zip Code:11715-1224
Practice Address - Country:US
Practice Address - Phone:516-738-3394
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-15
Last Update Date:2020-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY77834801163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse