JALISA JONIQUE MCCULLOUGH


Address: 300 Crittenden Boulevard Box Psych, Rochester, NY 14642-0001
Phone: 5852753592

JALISA JONIQUE MCCULLOUGH (NPI# 1730702077) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).

Provider Overview

Nation Provider ID (NPI) 1730702077
Entity Type Individual
Full Name JALISA JONIQUE MCCULLOUGH
Credential PMHNP
Practice Address 300 Crittenden Boulevard Box Psych
Rochester
NY 14642-0001
Mailing Address 604 Suburban Ct Apt 2
Rochester
NY 14620-3837
Practice Telephone 5852753592
Mailing Telephone 5853092363
Enumeration Date 2020-05-21
Last Update Date 2020-05-21
Gender Code F
Is Sole Proprietor Y

Taxonomy

Primary Taxonomy Code Classification License Number License State Taxonomy Group
Y 363LP0808X Nurse Practitioner
Specialization: Psych/Mental Health
402978 NY Physician Assistants & Advanced Practice Nursing Providers

Office Location

Street Address 300 CRITTENDEN BOULEVARD BOX PSYCH
City ROCHESTER
State NY
Zip Code 14642-0001

Providers in the same location

NPI Name Taxonomy Address Enumeration
1568403715 Leslie Kaiser Nurse Practitioner 300 Crittenden Boulevard Box Psych, Rochester, NY 14642-0001 2006-06-09
1780849521 Kimberly Corey Trombly Nurse Practitioner 300 Crittenden Boulevard Box Psych, Rochester, NY 14642-0001 2008-07-21

Providers in the same zip code

NPI Name Taxonomy Address Enumeration
1679192363 Nicholas Campbell Love Student in an Organized Health Care Education/Training Program 601 Elmwood Ave, Ac-5, General Medicine Clinic 696, Rochester, NY 14642 2020-04-13
1750900650 Phillip Braun Student in an Organized Health Care Education/Training Program 601 Elmwood Ave, Ac-5 General Medicine Clinic 696, Rochester, NY 14642 2020-04-10
1437786993 Andrew Jeong Student in an Organized Health Care Education/Training Program Department of Orthopaedics and Rehabilitation, 601 Elmwood Avenue, Rochester, NY 14642 2020-03-25
1497227094 Alison Kent Pediatrics Dept of Pediatrics, University of Rochester, 601 Elmwood Avenue, Rochester, NY 14642 2018-12-20
1326539909 Saumya Goel Aujla Student in an Organized Health Care Education/Training Program 601 Elmwood Ave # 664, Rochester, NY 14642 2018-05-19
1922505387 Daniel Bral Student in an Organized Health Care Education/Training Program 601 Elmwood Ave # 655, Rochester, NY 14642 2018-04-11
1194222513 Jonah Meyerhoff Student in an Organized Health Care Education/Training Program 300 Crittenden Blvd Department of Psychiatry, Rochester, NY 14642 2018-04-11
1144738949 Francis Michael Manzo Registered Nurse University of Rochester 601 Elmwood Ave Box Surg, Rochester, NY 14642 2018-01-15
1225552649 George Norman Abraham Internal Medicine 600 Elmwood Avenue, University of Rochester, Rochester, NY 14642 2017-07-27
1861928301 Sonia Thakur Student in an Organized Health Care Education/Training Program 601 Elmwood University of Rochester Medical Center, Department of Physicial Medicine and Rehabilitation, Rochester, NY 14642 2017-05-03
Find all providers in zip 14642

Taxonomy Information

Taxonomy Code 363LP0808X
Grouping Physician Assistants & Advanced Practice Nursing Providers
Classification Nurse Practitioner
Specialization Psych/Mental Health

Taxonomy Definition

Definition to come...

Providers in the same taxonomy and city

NPI Name Taxonomy Address Enumeration
1659989804 Christopher Grant Miles Nurse Practitioner 1425 Portland Ave Ste 206, Wilson Bldg, Rochester, NY 14621-3011 2020-07-14
1497303150 Tatenda Valentine Rudziva Nurse Practitioner 2989 315 Elton Hills Drive Nw, Suite 201, Rochester, MN 55901 2019-08-27
1063066272 Keighley Loveland Nurse Practitioner 315 Science Pkwy Ste 500, Rochester, NY 14620-4257 2019-07-25
1396308375 Adonye T Afonya Nurse Practitioner 315 Elton Hills Dr Nw Ste 201, Rochester, MN 55901-2989 2019-04-16
1497280382 Roslynn Porter Nurse Practitioner 77 Colvin St, Rochester, NY 14611-2136 2017-04-27
1235589300 Andrew Cyrus Marcy Nurse Practitioner 95 Allens Creek Road Bld 1 Ste 306, Rochester, NY 14618 2016-06-20
1588049258 Lisa Parnell Nurse Practitioner 200 East River Road, Rochester, NY 14623 2015-07-23
1942602198 Deirdre Mary Kelley Nurse Practitioner 1111 Elmwood Ave Bldg 16, Rochester, NY 14620-3005 2014-09-18
1083014070 M Elizabeth Rowe Nurse Practitioner 1645 Saint Paul St, Rochester, NY 14621-3162 2014-08-27
1639587009 Sean Patrick Murphy Nurse Practitioner 95 Allens Creek Road, Building 1 Suite 306, Rochester, NY 14618 2014-07-29
Find all providers in ROCHESTER

Competitor

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City ROCHESTER
Zip Code 14642

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Dataset Information

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.

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