Healthcare Provider Details

I. General information

NPI: 1366333866
Provider Name (Legal Business Name): WHITNEY JORDAN KSCHINKA PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2025
Last Update Date: 11/24/2025
Certification Date: 11/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1768 ROUTE 9
HALFMOON NY
12065-2402
US

IV. Provider business mailing address

121 EVERETT RD
ALBANY NY
12205-1474
US

V. Phone/Fax

Practice location:
  • Phone: 518-489-2663
  • Fax:
Mailing address:
  • Phone: 518-489-2663
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number034624
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: