Provider Demographics
NPI:1477161321
Name:KENIS, SARAH KATHRYN (APRN)
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:KATHRYN
Last Name:KENIS
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:706 PAISLEY CT
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28409-3121
Mailing Address - Country:US
Mailing Address - Phone:703-489-1630
Mailing Address - Fax:
Practice Address - Street 1:800 3RD AVE FRNT A
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10022-7604
Practice Address - Country:US
Practice Address - Phone:516-210-5600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-16
Last Update Date:2025-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95025724363L00000X
CT12702363L00000X
DC500021734363L00000X
DC21734363L00000X
FL11007939363L00000X, 363LP0200X
MI4704409486363L00000X
NJ15199100363L00000X
NY383635363L00000X
TX1124906363L00000X
VT0136652363L00000X
VA0024185549363L00000X
WV117457363L00000X
NC5022550363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner