DR. JEFFREY K MCKENNA (NPI# 1396713780) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1396713780 |
| Entity Type | Individual |
| Full Name | DR. JEFFREY K MCKENNA |
| Credential | MD |
| Practice Address |
100 Deerpath Charleston IL 61920-9427 |
| Mailing Address |
3024 E Empire St Second Floor Ste E & F Bloomington IL 61704-5402 |
| Practice Telephone | 2172348000 |
| Practice Fax Number | 2172348003 |
| Mailing Telephone | 3094513376 |
| Mailing Fax Number | 3094523376 |
| Enumeration Date | 2006-03-10 |
| Last Update Date | 2019-08-05 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 207N00000X | Dermatology | 036-118958 | IL | Allopathic & Osteopathic Physicians |
| Y | 207ND0101X |
Dermatology Specialization: MOHS-Micrographic Surgery |
036.118958 | IL | Allopathic & Osteopathic Physicians |
| N | 207NS0135X |
Dermatology Specialization: Procedural Dermatology |
036-118958 | IL | Allopathic & Osteopathic Physicians |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 3024 E Empire St Ste Eandf, Bloomington, IL 617045402 | 3094513376 | 3094523376 |
| 4909 N Glen Park Place Rd, Peoria, IL 616144676 | 3096747546 | 3092820500 |
| 530 Park Ave E Ste 204, Princeton, IL 613563902 | 8158424000 | 3094523376 |
| 600 S 13th St, Pekin, IL 615544936 | 3096937788 | 3094523376 |
| 920 West St Ste 212, Peru, IL 613542769 | 8158424000 | 8152238736 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1568723070 | Jeffrey Ross Mckenna | Registered Nurse | 225 Penn Ave, Wilkinsburg, PA 15221-2148 | 2012-05-31 |
| 1609812296 | Jeffrey A Mckenna | Otolaryngology | 5110 E Warner Rd, Suite 100, Phoenix, AZ 85044-3367 | 2006-06-21 |
| Street Address |
100 DEERPATH |
| City | CHARLESTON |
| State | IL |
| Zip Code | 61920-9427 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1558613489 | Bella Family Health and Wellness, LLC | Family Medicine | 100 Deerpath, Charleston, IL 61920-9427 | 2012-10-02 |
| 1326207184 | James D Pitts | Physician Assistant | 100 Deerpath, Charleston, IL 61920-9427 | 2008-06-06 |
| 1881872984 | Maria Horvat Md Sc | Obstetrics & Gynecology | 100 Deerpath, Charleston, IL 61920-9427 | 2008-01-31 |
| 1932386505 | James M Kohlmann Md Sc | Orthopaedic Surgery | 100 Deerpath, Charleston, IL 61920-9427 | 2008-01-26 |
| 1417072422 | Michael Gillmore | Registered Nurse | 100 Deerpath, Charleston, IL 61920-9427 | 2007-03-20 |
| 1215948146 | Manoj Kohli | Internal Medicine | 100 Deerpath, Charleston, IL 61920 | 2006-08-09 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1124643879 | Jenna Kay Mortensen | Speech-Language Pathologist | 2086 7th Street, Charleston, IL 61920 | 2020-06-09 |
| 1255954566 | Christina L. White | Nurse Practitioner | 1199 Persimmon Rd, Charleston, IL 61920 | 2020-05-20 |
| 1679066773 | Jennifer Hess | Specialist/Technologist | 2506 Lantz Building, Charleston, IL 61920 | 2018-06-13 |
| 1134647969 | Nichole C Ogilvie | Student in an Organized Health Care Education/Training Program | 917 4th Street Apt 19, Charleston, IL 61920 | 2017-08-31 |
| 1467970319 | Marcus Roach | Physical Therapy Assistant | 912 Oakcrest Dr. Apt D, Charleston, IL 61920 | 2017-08-30 |
| 1114478500 | 5 Guys Rx II LLC | Pharmacy | 1 W Lincoln Ave, Charleston, IL 61920 | 2016-10-20 |
| 1649723206 | Bright Minds Educational Program Inc | Developmental Therapist | 7704 Deerpath Road, Charleston, IL 61920 | 2016-08-01 |
| 1760843379 | Lisa Price | Nurse Practitioner | 2040 Lincoln Ave, Suite 100, Charleston, IL 61920 | 2016-03-09 |
| 1104243385 | Nathan David Schwartzkopf | Specialist/Technologist | 1340 A Street, Charleston, IL 61920 | 2014-03-25 |
| 1558694349 | Emily Schilling | Specialist/Technologist | 2350 Harrison Avenue, Charelston, IL 61920 | 2009-09-10 |
| Find all providers in zip 61920 | ||||
| Taxonomy Code | 207ND0101X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Dermatology |
| Specialization | MOHS-Micrographic Surgery |
| The highly-trained surgeons that perform Mohs Micrographic Surgery are specialists both in dermatology and pathology. With their extensive knowledge of the skin and unique pathological skills, they are able to remove only diseased tissue, preserving healthy tissue and minimizing the cosmetic impact of the surgery. Mohs surgeons who belong to the American College of Mohs Surgery (ACMS) have completed a minimum of one year of fellowship training at one of the ACMS-approved training centers in the U.S. |
| Notes: Source: American College of Mohs Surgery, 2007 [1/1/2008: added definition, added source] Additional Resources: Additional Resources: http://www.mohscollege.org/; American Board of Dermatology, 2007. http://www.abderm.org/ |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1912479056 | Beckley Dermatology Inc. | Dermatology | 300 Kenton Dr Ste 2, Charleston, WV 25311-1266 | 2018-12-31 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1295374270 | Lilly Aesthetics Sc | Dermatology | 2500 S Highland Ave Ste 220, Lombard, IL 60148-7103 | 2019-12-23 |
| 1194270637 | University Dermatology and Vein Clinic LLC | Dermatology | 8110 Cass Ave, Darien, IL 60561-5013 | 2016-08-24 |
| 1174984959 | Advanced Skin and Mohs Surgery Center S.c. | Dermatology | 2845 N. Sheridan Road, Ste 912, Chicago, IL 60657 | 2016-03-08 |
| 1376915629 | Forefront Dermatology, S.c. | Dermatology | 1520 Bond St, Naperville, IL 60563 | 2015-10-27 |
| 1710294756 | Tracy Campbell Md LLC | Dermatology | 675 W North Ave Ste 506, Melrose Park, IL 60160-1626 | 2010-09-13 |
| 1932388865 | Marsh Dermatology, Sc | Dermatology | 1252 American Way, Libertyville, IL 60048-3936 | 2007-10-27 |
| 1538200308 | Omeed Memar | Dermatology | 50 E Washington St Ste 200, Chicago, IL 60602-2154 | 2007-02-12 |
| 1891721965 | Aleksandar L Krunic | Dermatology | 5140 N California Ave Ste 660, Chicago, IL 60625-3664 | 2006-06-23 |
| 1073595690 | Ashish C Bhatia | Dermatology | 550 E Devon Ave Ste 200, Itasca, IL 60143-2639 | 2005-11-18 |
| 1538153960 | Sharon Louise Horton | Dermatology | 1049 E Wilson St, Suite 190, Batavia, IL 60510-2474 | 2005-08-31 |
| Find all providers with the same taxonomy | ||||
| City | CHARLESTON |
| Zip Code | 61920 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.