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General NPI Number Information
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NPI Number | 1225453715
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Entity Type | Individual
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Provider Name | JACQUELINE DONGMO MEKONTCHOU
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Gender | Female
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Dates
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Enumeration Date | 02/20/2014
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Last Update Date | 09/22/2023
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Provider Practice Location Address
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Address Line | 800 CROSS RIVER RD
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City | KATONAH
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State | NY
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Zip | 10536-3549
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Country | US
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Telephone | 347-898-0813
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Fax |
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Provider Business Mailing Address
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Address Line | 225EAST 149TH STREET APT. 17G
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City | BRONX
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State | NY
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Zip | 10451
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Country | US
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Telephone | 347-898-0813
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | F403298
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | F403298
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License Number State | NY
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