Judith McKenna, RN, NP

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

4704145383 Issued in MI

Practice address

15855 19 Mile Rd
Clinton Township, MI 48038-3504

Phone

(586) 295-5387

Fax

(810) 794-4124

NPI assigned

Nov 4, 2005

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 identifiers 1

Medicare fee-for-service enrollment

Enrolled in MI

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner, Registered Nurse

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Michigan Post-Acute Medical Services 1 PC

  • Hospitalist Physician
  • Brighton, MI
  • NPI 1669901567
  Medicare reassignment NPD
• Theoria Medical

  • Internal Medicine Physician
  • Novi, MI
  • NPI 1609362375

  Nurse Practitioner

  Medicare reassignment NPD
• CS Pacs 3 Midwest LLC

  • Hospitalist Physician
  • Dayton, OH
  • NPI 1972368785

  MI

  Medicare reassignment NPD
• Mi Pacs 2 PC

  • Hospitalist Physician
  • Northville, MI
  • NPI 1205418357
  NPD
• NV Pacs 2 LLC

  • Hospitalist Physician
  • Las Vegas, NV
  • NPI 1427534809
  NPD (past)

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

{
    "created_epoch": "1131062400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1243382400000",
    "number": "1255322467",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15855 19 MILE RD",
            "city": "CLINTON TOWNSHIP",
            "state": "MI",
            "postal_code": "480383504",
            "telephone_number": "586-295-5387",
            "fax_number": "810-794-4124"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15855 19 MILE RD",
            "city": "CLINTON TOWNSHIP",
            "state": "MI",
            "postal_code": "480383504",
            "telephone_number": "586-295-5387",
            "fax_number": "810-794-4124"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCKENNA",
        "first_name": "JUDITH",
        "name_prefix": "Ms.",
        "credential": "RN, NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-11-04",
        "last_updated": "2009-05-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "MI",
            "license": "4704145383",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4605447",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kristen McGee
• MCGH Comprehensive Breast Screening Center LLC
• Julia E McGowen-Bienkowski, LPC
• Lisa McInnis, RN
• Carol Lee McKay, LBSW, MSA
• Amy L McKenzie, MD
• Brandon R McKenzie, DC
• Krysti McKenzie, OTR
• Kay McKnight
• McLaren Macomb

• Nurse Practitioner in Clinton Township, MI
• Providers in Clinton Township, MI by specialty
• Nurse Practitioner in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 27, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.