Provider Demographics
NPI:1194981290
Name:MCKENDRY, GINA E (PA-C)
Entity type:Individual
Prefix:
First Name:GINA
Middle Name:E
Last Name:MCKENDRY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 159
Mailing Address - Street 2:
Mailing Address - City:BARRINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08007-0159
Mailing Address - Country:US
Mailing Address - Phone:888-982-8594
Mailing Address - Fax:888-920-1525
Practice Address - Street 1:410 N KROCKS RD
Practice Address - Street 2:
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18106-9283
Practice Address - Country:US
Practice Address - Phone:888-982-8594
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-29
Last Update Date:2024-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA0A002355363A00000X
PAMA053491363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0TH000Medicare UPIN
PA135996FCQMedicare Oscar/Certification