Provider Demographics
NPI:1982132064
Name:MCKEVITT, JENNIFER JILL (LPN)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:JILL
Last Name:MCKEVITT
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28 OAKWOOD DR
Mailing Address - Street 2:
Mailing Address - City:SHIRLEY
Mailing Address - State:NY
Mailing Address - Zip Code:11967-3941
Mailing Address - Country:US
Mailing Address - Phone:631-399-4969
Mailing Address - Fax:
Practice Address - Street 1:28 OAKWOOD DR
Practice Address - Street 2:
Practice Address - City:SHIRLEY
Practice Address - State:NY
Practice Address - Zip Code:11967-3941
Practice Address - Country:US
Practice Address - Phone:631-399-4969
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-01
Last Update Date:2017-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY328078-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse