Individual ProviderKathleen Anne NultyLicensed Practical NurseNursing Service ProvidersPractice Address29 S Prospect Ave, Patchogue, NY 11772-3209(631) 879-7614PECOS EnrollmentBased on the most recent information from CMS, provider Kathleen Anne Nulty does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records 2 days ago.Profile DetailsProvider ID1225211527Provider TypeIndividualFull NameNulty, Kathleen AnneCredentialLPNGenderFemaleSole ProprietorYesEnumeration Date12/10/2007Last Updated12/10/2007Contact InformationPractice LocationPractice Address29 S Prospect Ave, Patchogue, NY 11772-3209Phone(631) 879-7614FaxUnlisted FaxMailing LocationMailing Address29 S Prospect Ave, Patchogue, NY 11772-3209Phone(631) 879-7614FaxUnlisted FaxProvider TaxonomiesCodeDescriptionLicenseCode164W00000XPrimaryDescriptionLicensed Practical NurseNursing Service ProvidersLicense23459701New York