MEDICARE: MICHAEL KENNETH MCKENERY MSN, CRNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner	SP017670	PA
2	163W00000X	Registered Nurse	RN697852	PA

General Provider Information

NPI Number	:	1275057911
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL KENNETH MCKENERY MSN, CRNP

Provider Business Mailing Address
First Line	:	240 PULLMAN SQ STE 255
Second Line	:
City	:	BUTLER
State	:	PA
Zip	:	16001-5654
Country	:	US
Telephone Number	:	724-431-4170
Fax Number	:

Provider Business Practice Location Address
First Line	:	240 PULLMAN SQ STE 255
Second Line	:
City	:	BUTLER
State	:	PA
Zip	:	16001-5654
Country	:	US
Telephone Number	:	724-431-4170
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/02/2017
Last Update Date	:	03/19/2026

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