Healthcare Provider Details

I. General information

NPI: 1982246310
Provider Name (Legal Business Name): JENNIFER MARSDEN KEKIS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/17/2019
Last Update Date: 10/17/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

260 S PEARL ST
ALBANY NY
12202-1809
US

IV. Provider business mailing address

6 WEDGEWOOD LN
VOORHEESVILLE NY
12186-9702
US

V. Phone/Fax

Practice location:
  • Phone: 518-447-4555
  • Fax:
Mailing address:
  • Phone: 518-362-6148
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberF402610-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: