Individual provider · NPI-1

Katlyn Ann Conville Anthony, NP

Nurse Practitioner, Family · Stony Brook, NY

NPI number1023679503
StatusActive
Last updated in NPPESOct 23, 2026

Details

NPI
1023679503
Entity type
Individual (NPI-1)
Name
Katlyn Ann Conville Anthony
Credential
NP
Sex
Female
Sole proprietor
No
Enumeration date
Jun 25, 2019
Certification date
Oct 23, 2026
Last updated
Oct 23, 2026

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
363LF0000X Nurse Practitioner, Family344632NYYes

Practice location

100 Nicolls Rd
Stony Brook, NY 11794-0001

Phone 631-689-8333

Mailing address

100 Nicolls Rd
Stony Brook, NY 11794-0001

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