Provider Demographics
NPI:1902845787
Name:KLIMEK-YINGLING, JENNIFER ANN (PHD, APRN, FNP-BC)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:ANN
Last Name:KLIMEK-YINGLING
Suffix:
Gender:F
Credentials:PHD, APRN, FNP-BC
Other - Prefix:DR
Other - First Name:JENNIFER
Other - Middle Name:ANN
Other - Last Name:KLIMEK-YINGLING
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHD, APRN,FNP-BC
Mailing Address - Street 1:1656 CHAMPLIN AVE
Mailing Address - Street 2:FAXTON ST. LUKES EMERGENCY DEPARTMENT
Mailing Address - City:UTICA
Mailing Address - State:NY
Mailing Address - Zip Code:13502-1238
Mailing Address - Country:US
Mailing Address - Phone:315-624-6068
Mailing Address - Fax:
Practice Address - Street 1:1656 CHAMPLIN AVE
Practice Address - Street 2:FAXTON ST. LUKES EMERGENCY DEPARTMENT
Practice Address - City:UTICA
Practice Address - State:NY
Practice Address - Zip Code:13502-1238
Practice Address - Country:US
Practice Address - Phone:315-624-6068
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2018-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF301957363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02092666Medicaid
NYJ400035623Medicare UPIN
NYJ400053798Medicare UPIN
NY02092666Medicaid