Provider Demographics
NPI:1659462711
Name:MCMURRY, JACQUELINE HELEN (PHYSICIAN ASSISTANT)
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:HELEN
Last Name:MCMURRY
Suffix:
Gender:F
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26 CROWNWOOD LN
Mailing Address - Street 2:
Mailing Address - City:QUEENSBURY
Mailing Address - State:NY
Mailing Address - Zip Code:12804-1018
Mailing Address - Country:US
Mailing Address - Phone:518-798-1932
Mailing Address - Fax:
Practice Address - Street 1:461 GLEN ST
Practice Address - Street 2:
Practice Address - City:GLENS FALLS
Practice Address - State:NY
Practice Address - Zip Code:12801-2906
Practice Address - Country:US
Practice Address - Phone:518-745-5889
Practice Address - Fax:518-745-0010
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007750-2363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0077502OtherLICENSE
NYP48205Medicare UPIN