Provider Demographics
NPI:1992069058
Name:MCKENNEY, JENIFER L (FNP)
Entity type:Individual
Prefix:MRS
First Name:JENIFER
Middle Name:L
Last Name:MCKENNEY
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:JENIFER
Other - Middle Name:M
Other - Last Name:PIPER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:43 WHITING HILL RD STE 300
Mailing Address - Street 2:
Mailing Address - City:BREWER
Mailing Address - State:ME
Mailing Address - Zip Code:04412-1006
Mailing Address - Country:US
Mailing Address - Phone:207-973-4670
Mailing Address - Fax:207-973-4669
Practice Address - Street 1:417 STATE STREET
Practice Address - Street 2:WEBBER WEST SUITE 141
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401
Practice Address - Country:US
Practice Address - Phone:207-973-4670
Practice Address - Fax:207-973-4669
Is Sole Proprietor?:No
Enumeration Date:2012-07-03
Last Update Date:2020-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECNP121061363LX0001X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily