Provider Demographics
NPI:1639699192
Name:MCKENNA, CHELSEA L (FNP)
Entity Type:Individual
Prefix:
First Name:CHELSEA
Middle Name:L
Last Name:MCKENNA
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:139 PROFESSIONAL PKWY
Mailing Address - Street 2:
Mailing Address - City:LOCKPORT
Mailing Address - State:NY
Mailing Address - Zip Code:14094-5369
Mailing Address - Country:US
Mailing Address - Phone:716-433-6711
Mailing Address - Fax:716-433-0546
Practice Address - Street 1:139 PROFESSIONAL PKWY
Practice Address - Street 2:
Practice Address - City:LOCKPORT
Practice Address - State:NY
Practice Address - Zip Code:14094-5369
Practice Address - Country:US
Practice Address - Phone:716-433-6711
Practice Address - Fax:716-433-0546
Is Sole Proprietor?:No
Enumeration Date:2017-06-26
Last Update Date:2017-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY341926363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily