Provider Demographics
NPI:1558456350
Name:MCKINLEY, M. BRIDGET (NP)
Entity Type:Individual
Prefix:
First Name:M. BRIDGET
Middle Name:
Last Name:MCKINLEY
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 1:9005 OLD RIVER RD STE 1
Mailing Address - Street 2:
Mailing Address - City:MARCY
Mailing Address - State:NY
Mailing Address - Zip Code:13403-3000
Mailing Address - Country:US
Mailing Address - Phone:315-765-3227
Mailing Address - Fax:315-765-3669
Practice Address - Street 1:9005 OLD RIVER RD
Practice Address - Street 2:
Practice Address - City:MARCY
Practice Address - State:NY
Practice Address - Zip Code:13403-3000
Practice Address - Country:US
Practice Address - Phone:315-765-3227
Practice Address - Fax:315-765-3669
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2019-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF333406 (FNP)363L00000X
NYF301623 (ANP)363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
RA6409Medicare ID - Type Unspecified
S83480Medicare UPIN