Healthcare Provider Details

I. General information

NPI: 1194981290
Provider Name (Legal Business Name): GINA E MCKENDRY PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/29/2008
Last Update Date: 08/13/2024
Certification Date: 08/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

410 N KROCKS RD
ALLENTOWN PA
18106-9283
US

IV. Provider business mailing address

PO BOX 159
BARRINGTON NJ
08007-0159
US

V. Phone/Fax

Practice location:
  • Phone: 888-982-8594
  • Fax:
Mailing address:
  • Phone: 888-982-8594
  • Fax: 888-920-1525

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0A002355
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberMA053491
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: