Provider Demographics
NPI:1437636156
Name:KEVILLE, VALERIE ANN (MS, CNM)
Entity type:Individual
Prefix:
First Name:VALERIE
Middle Name:ANN
Last Name:KEVILLE
Suffix:
Gender:F
Credentials:MS, CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:725 IRVING AVE
Mailing Address - Street 2:STE 600
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13210
Mailing Address - Country:US
Mailing Address - Phone:315-464-5162
Mailing Address - Fax:315-464-2122
Practice Address - Street 1:725 IRVING AVE
Practice Address - Street 2:STE 600
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13210
Practice Address - Country:US
Practice Address - Phone:315-464-5162
Practice Address - Fax:315-464-2122
Is Sole Proprietor?:No
Enumeration Date:2018-07-25
Last Update Date:2025-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001875176B00000X, 367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No176B00000XOther Service ProvidersMidwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY001875OtherNYS CNM LICENSE
CNM05028OtherAMCB
NY571906-1OtherNYS RN