Healthcare Provider Details

I. General information

NPI: 1023594041
Provider Name (Legal Business Name): JENNIFER MEHLING FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2018
Last Update Date: 07/12/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 S PERRY ST
JOHNSTOWN NY
12095-3213
US

IV. Provider business mailing address

169 HINDS RD
GALWAY NY
12074-2330
US

V. Phone/Fax

Practice location:
  • Phone: 518-762-3161
  • Fax:
Mailing address:
  • Phone: 518-788-6137
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number343312
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: