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General NPI Number Information
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NPI Number | 1780045724
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Entity Type | Individual
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Provider Name | JENNIFER KANALY
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Gender | Female
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Dates
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Enumeration Date | 03/18/2016
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Last Update Date | 09/09/2020
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Provider Practice Location Address
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Address Line | 287 JOHN BOSWELL RD
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City | PERU
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State | NY
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Zip | 12972
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Country | US
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Telephone | 518-420-2073
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Fax | 518-763-0895
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Provider Business Mailing Address
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Address Line | 75 BEEKMAN ST
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City | PLATTSBURGH
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State | NY
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Zip | 12901-1438
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Country | US
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Telephone | 518-562-7790
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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 | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 401976
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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 | 40 401976
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License Number State | NY
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