Provider Demographics
NPI:1811614670
Name:MCCOOL, KATIE A SCHAEFFER (FNP-C)
Entity type:Individual
Prefix:
First Name:KATIE
Middle Name:A SCHAEFFER
Last Name:MCCOOL
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3170 WEST ST STE 150
Mailing Address - Street 2:
Mailing Address - City:CANANDAIGUA
Mailing Address - State:NY
Mailing Address - Zip Code:14424-1786
Mailing Address - Country:US
Mailing Address - Phone:585-396-6977
Mailing Address - Fax:
Practice Address - Street 1:1160 CORPORATE DR
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:NY
Practice Address - Zip Code:14425-9534
Practice Address - Country:US
Practice Address - Phone:585-924-1510
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-24
Last Update Date:2023-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY350042363A00000X
NYF350042-1363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant