Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Kayla Emily Provenzano, FNP

Individual provider Family Nurse Practitioner · NPI 1609599307

Kayla Emily Provenzano, FNP is a Nurse Practitioner in Riverhead, New York. Qualified in 2022, 4 years ago. Practices with North Shore-Lij Medical PC, a 6,350-clinician group and accepts Medicare assignment. Licensed in New York.

Years since qualifying
4
Licensed in
NY
In the registry since
2022
What do these letters mean?
FNP — Family Nurse Practitioner
A nurse practitioner who treats patients of all ages, much like a family doctor.

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Practice location Address checks out

1272 E Main St
Riverhead, NY 11901-2583
Phone: (631) 284-3797
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Family Nurse Practitioner (primary) Taxonomy 363LF0000X · Licence 350411 (NY)

Record details

NPI number1609599307
Entity typeIndividual (Type 1)
GenderFemale
Credentials FNP
Sole proprietorYes
NPI enumeratedSeptember 19, 2022
Last updated in NPPESSeptember 19, 2022
Certification dateSeptember 19, 2022

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyNURSE PRACTITIONER
Medical schoolOTHER
Graduated 2022 (4 years in practice)
Group practice North Shore-Lij Medical Pc — 6350 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

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