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).
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 |
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 |
Street Address |
300 CRITTENDEN BOULEVARD BOX PSYCH |
City | ROCHESTER |
State | NY |
Zip Code | 14642-0001 |
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 |
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 Code | 363LP0808X |
Grouping | Physician Assistants & Advanced Practice Nursing Providers |
Classification | Nurse Practitioner |
Specialization | Psych/Mental Health |
Definition to come... |
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 |
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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.