Provider Demographics
NPI:1184340150
Name:JANKOWIAK, KIMBERLY ROSE (PMHNP-BC)
Entity type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:ROSE
Last Name:JANKOWIAK
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 JOHN GLENN DR STE 1
Mailing Address - Street 2:
Mailing Address - City:AMHERST
Mailing Address - State:NY
Mailing Address - Zip Code:14228-2213
Mailing Address - Country:US
Mailing Address - Phone:716-862-2059
Mailing Address - Fax:716-961-2720
Practice Address - Street 1:210 JOHN GLENN DR STE 1
Practice Address - Street 2:
Practice Address - City:AMHERST
Practice Address - State:NY
Practice Address - Zip Code:14228-2213
Practice Address - Country:US
Practice Address - Phone:716-862-2059
Practice Address - Fax:716-961-2720
Is Sole Proprietor?:No
Enumeration Date:2022-10-12
Last Update Date:2022-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF404240-01363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health