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

Individual provider Adult Health Nurse Practitioner · NPI 1043659980

Kenneth William Nissen, ANP is a Nurse Practitioner in Port Jefferson, New York. Graduated from State University of New York at Stony Brook, School of Medicine in 2012, 14 years ago. Practices with True North Medical Group PC, a 186-clinician group and accepts Medicare assignment. Licensed in New York.

Years since qualifying
14
Trained at
State University of New York at Stony Brook, School of Medicine
Licensed in
NY
In the registry since
2013
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Practice location Address checks out

75 N Country Rd
Port Jefferson, NY 11777-2119
Phone: (631) 476-2786
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Adult Health Nurse Practitioner (primary) Taxonomy 363LA2200X · Licence 306258 (NY)

Record details

NPI number1043659980
Entity typeIndividual (Type 1)
GenderMale
Credentials ANP
Sole proprietorYes
NPI enumeratedJune 24, 2013
Last updated in NPPESJune 24, 2013

Medicare enrollment

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

Medicare specialtyNURSE PRACTITIONER
Medical schoolSTATE UNIVERSITY OF NEW YORK AT STONY BROOK, SCHOOL OF MEDICINE
Graduated 2012 (14 years in practice)
Group practice True North Medical Group Pc — 186 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

Other providers in Port Jefferson