Provider Demographics
NPI:1518234640
Name:DOYLE, JENNY M (NP)
Entity Type:Individual
Prefix:
First Name:JENNY
Middle Name:M
Last Name:DOYLE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:75 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:POUGHKEEPSIE
Mailing Address - State:NY
Mailing Address - Zip Code:12601-2303
Mailing Address - Country:US
Mailing Address - Phone:845-790-7990
Mailing Address - Fax:845-790-9036
Practice Address - Street 1:75 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:POUGHKEEPSIE
Practice Address - State:NY
Practice Address - Zip Code:12601-2303
Practice Address - Country:US
Practice Address - Phone:845-790-7990
Practice Address - Fax:845-790-9036
Is Sole Proprietor?:No
Enumeration Date:2011-11-17
Last Update Date:2021-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY645101163W00000X
NY338514363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03994718Medicaid