Jennifer Michele McKeon, PHD, ATC, CSCS

Primary specialty

Athletic TrainerTaxonomy code 2255A2300X

License

002667 Issued in NY

Practice address

953 Danby Road
Hill Center, Room G65
Ithaca, NY 14850-7002

Phone

(607) 274-1456

NPI assigned

May 19, 2020

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Jennifer Michele Medina Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Philosophy

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1589846400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1589846400000",
    "number": "1215550827",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "953 DANBY ROAD",
            "address_2": "HILL CENTER, ROOM G65",
            "city": "ITHACA",
            "state": "NY",
            "postal_code": "148507002",
            "telephone_number": "607-274-1456"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "953 DANBY ROAD",
            "address_2": "HILL CENTER, ROOM G65",
            "city": "ITHACA",
            "state": "NY",
            "postal_code": "148507002",
            "telephone_number": "607-274-1456"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCKEON",
        "first_name": "JENNIFER",
        "middle_name": "MICHELE",
        "name_prefix": "Dr.",
        "credential": "PHD, ATC, CSCS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-05-19",
        "last_updated": "2020-05-19",
        "certification_date": "2020-05-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "NY",
            "license": "002667",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JENNIFER",
            "last_name": "MEDINA",
            "middle_name": "MICHELE",
            "credential": "MS, ATC, CSCS",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Deborah D McIntyre, RN NP
• Laurel Anna McIntyre, LMHC
• Penny McKane, RN
• Christian Heather McKeithen, PA
• Susan McKernan McKelvey, FNP
• Nancy McKeon
• Patrick Owen McKeon, PHD, ATC, CSCS
• Beth Suzanne McKinney, RDN
• Kjersten Lydia McKinniss, ATC
• Niklas James McKone

• Athletic Trainer in Ithaca, NY
• Providers in Ithaca, NY by specialty
• Athletic Trainer in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 19, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.