Provider Demographics
NPI:1760469290
Name:PENDELL-MCKEE, JUDY ANN (FNPC)
Entity Type:Individual
Prefix:
First Name:JUDY
Middle Name:ANN
Last Name:PENDELL-MCKEE
Suffix:
Gender:F
Credentials:FNPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:346 GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:NY
Mailing Address - Zip Code:13790-2580
Mailing Address - Country:US
Mailing Address - Phone:607-656-4115
Mailing Address - Fax:607-656-9553
Practice Address - Street 1:15 BIRDSALL ST
Practice Address - Street 2:
Practice Address - City:GREENE
Practice Address - State:NY
Practice Address - Zip Code:13778-1057
Practice Address - Country:US
Practice Address - Phone:607-656-4115
Practice Address - Fax:607-656-9553
Is Sole Proprietor?:No
Enumeration Date:2005-12-27
Last Update Date:2014-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY330475363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01903199Medicaid
NY01903199Medicaid