Healthcare Provider Details

I. General information

NPI: 1558456350
Provider Name (Legal Business Name): M. BRIDGET MCKINLEY NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 11/12/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9005 OLD RIVER RD
MARCY NY
13403-3000
US

IV. Provider business mailing address

9005 OLD RIVER RD STE 1
MARCY NY
13403-3000
US

V. Phone/Fax

Practice location:
  • Phone: 315-765-3227
  • Fax: 315-765-3669
Mailing address:
  • Phone: 315-765-3227
  • Fax: 315-765-3669

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberF333406 (FNP)
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberF301623 (ANP)
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: