Provider Demographics
NPI:1912751405
Name:KOONINGS, JENNIFER ELAINE (PMHNP)
Entity Type:Individual
Prefix:MISS
First Name:JENNIFER
Middle Name:ELAINE
Last Name:KOONINGS
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3149 29TH ST APT D5
Mailing Address - Street 2:
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11106-3312
Mailing Address - Country:US
Mailing Address - Phone:415-596-2129
Mailing Address - Fax:
Practice Address - Street 1:200 TILLARY ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11201-3010
Practice Address - Country:US
Practice Address - Phone:718-855-7485
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-12
Last Update Date:2024-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF405573-01363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health