Provider Demographics
NPI:1184817215
Name:YONKER, TERRY JEAN (PMHNP-BC)
Entity Type:Individual
Prefix:MS
First Name:TERRY
Middle Name:JEAN
Last Name:YONKER
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3458 LYON RD
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:NY
Mailing Address - Zip Code:14505-9443
Mailing Address - Country:US
Mailing Address - Phone:315-310-7148
Mailing Address - Fax:315-310-7148
Practice Address - Street 1:42 N MAIN ST
Practice Address - Street 2:
Practice Address - City:CANANDAIGUA
Practice Address - State:NY
Practice Address - Zip Code:14424-1446
Practice Address - Country:US
Practice Address - Phone:585-319-0014
Practice Address - Fax:585-393-0014
Is Sole Proprietor?:No
Enumeration Date:2007-08-22
Last Update Date:2021-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF334053-1363L00000X
NY402420363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02700145Medicaid
NYJ400000345Medicare PIN