Provider Demographics
NPI:1649401902
Name:COONEY, PRISCILLA A (CRNP)
Entity Type:Individual
Prefix:
First Name:PRISCILLA
Middle Name:A
Last Name:COONEY
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:382 PIERCE ST
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:PA
Mailing Address - Zip Code:18704-5535
Mailing Address - Country:US
Mailing Address - Phone:570-288-7231
Mailing Address - Fax:570-331-4616
Practice Address - Street 1:382 PIERCE ST
Practice Address - Street 2:
Practice Address - City:KINGSTON
Practice Address - State:PA
Practice Address - Zip Code:18704-5535
Practice Address - Country:US
Practice Address - Phone:570-288-7231
Practice Address - Fax:570-331-4616
Is Sole Proprietor?:No
Enumeration Date:2009-08-05
Last Update Date:2009-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP010397363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA163199FZ4Medicare PIN