Provider Demographics
NPI:1760642979
Name:MCKEON, ELIZABETH M (FNP)
Entity Type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:M
Last Name:MCKEON
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:
Other - Last Name:CARNEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6075 JUDD RD
Mailing Address - Street 2:
Mailing Address - City:ORISKANY
Mailing Address - State:NY
Mailing Address - Zip Code:13424
Mailing Address - Country:US
Mailing Address - Phone:315-765-2362
Mailing Address - Fax:315-765-2323
Practice Address - Street 1:6075 JUDD RD
Practice Address - Street 2:
Practice Address - City:ORISKANY
Practice Address - State:NY
Practice Address - Zip Code:13424
Practice Address - Country:US
Practice Address - Phone:315-765-2362
Practice Address - Fax:315-765-2323
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-11
Last Update Date:2008-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF330251363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner