Provider Demographics
NPI:1447289236
Name:FEDKIW, KIMBERLY FAITH (FNP, ANP)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:FAITH
Last Name:FEDKIW
Suffix:
Gender:F
Credentials:FNP, ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4267 TRANSIT RD
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221-7205
Mailing Address - Country:US
Mailing Address - Phone:716-204-0798
Mailing Address - Fax:716-632-2457
Practice Address - Street 1:4267 TRANSIT RD
Practice Address - Street 2:
Practice Address - City:WILLIAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14221-7205
Practice Address - Country:US
Practice Address - Phone:716-204-0798
Practice Address - Fax:716-632-2457
Is Sole Proprietor?:No
Enumeration Date:2006-07-02
Last Update Date:2020-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF333039-1363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02672984Medicaid
NY00060970004OtherBLUE CROSS/BLUE SHIEL
NY00027261403OtherUNIVERA
NYF333039-1OtherLICENSE
Q49873Medicare UPIN
NYRB6638Medicare PIN
NY00060970004OtherBLUE CROSS/BLUE SHIEL