Provider Demographics
NPI:1710379086
Name:MCDEVITT, JACKIE J (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:JACKIE
Middle Name:J
Last Name:MCDEVITT
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:JACKIE
Other - Middle Name:T
Other - Last Name:PRICE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1000 N VILLAGE AVE
Mailing Address - Street 2:MERCY MEDICAL CENTER
Mailing Address - City:ROCKVILLE CENTRE
Mailing Address - State:NY
Mailing Address - Zip Code:11570
Mailing Address - Country:US
Mailing Address - Phone:516-705-2854
Mailing Address - Fax:
Practice Address - Street 1:1000 N VILLAGE AVE
Practice Address - Street 2:MERCY MEDICAL CENTER
Practice Address - City:ROCKVILLE CENTRE
Practice Address - State:NY
Practice Address - Zip Code:11570
Practice Address - Country:US
Practice Address - Phone:516-705-2854
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-24
Last Update Date:2017-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY018462146M00000X, 363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No146M00000XEmergency Medical Service ProvidersEmergency Medical Technician, Intermediate