Provider Demographics
NPI:1225812951
Name:BERNITT, MCKINLEY (PA-C)
Entity Type:Individual
Prefix:
First Name:MCKINLEY
Middle Name:
Last Name:BERNITT
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32 THOMPSON SQUARE MALL STE 5
Mailing Address - Street 2:
Mailing Address - City:MONTICELLO
Mailing Address - State:NY
Mailing Address - Zip Code:12701-3220
Mailing Address - Country:US
Mailing Address - Phone:845-791-6400
Mailing Address - Fax:
Practice Address - Street 1:32 THOMPSON SQUARE MALL STE 5
Practice Address - Street 2:
Practice Address - City:MONTICELLO
Practice Address - State:NY
Practice Address - Zip Code:12701-3220
Practice Address - Country:US
Practice Address - Phone:845-791-6400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-23
Last Update Date:2023-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY030479363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant