Tina Marie McKennon, CRNP

Primary specialty

Adult Health Nurse PractitionerTaxonomy code 363LA2200X

License

SP015746 Issued in PA

Practice address

51 N 39TH Street
Cupp Building 1St Floor
Philadelphia, PA 19104-2640

Phone

(215) 662-9801

Fax

(215) 243-3249

NPI assigned

Jan 28, 2016

Last updated

Jun 29, 2022By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in PA, NJ2 enrollments

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 2

Specialty

Nurse Practitioner

Education

Jefferson Medical College of Thomas Jefferson University, 2013

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Clinical Healthcare Associates of New Jersey Specialty Practices PCGroup PAC ID 9335655026, 43 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Penn Presbyterian Medical Center Hospital, Philadelphia, PA, CCN 390223
• West Jersey Hospital Hospital, Voorhees, NJ, CCN 310022

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Clinical Healthcare Associates of New Jersey Specialty Practices PC

  • Hematology & Oncology Physician
  • Cherry Hill, NJ
  • NPI 1104632546
  Medicare reassignment Care Compare group NPD
• University of Penn-Medical Group

  • Hematology & Oncology Physician
  • Philadelphia, PA
  • NPI 1679677975
  Medicare reassignment NPD
• Clinical Health Care Associates of New Jersey, PC

  • Pulmonary Disease Physician
  • Cherry Hill, NJ
  • NPI 1508019241
  Medicare reassignment NPD
• Clinical Healthcare Associates of New Jersey Specialty Practices PC

  • Internal Medicine Physician
  • Bala Cynwyd, PA
  • NPI 1104630714
  NPD
• University of Penn-Medical Group

  • Surgical Oncology Physician
  • Philadelphia, PA
  • NPI 1871981985
  NPD
• Clinical Health Care Associates of New Jersey, P.C.

  • Family Medicine Physician
  • Cherry Hill, NJ
  • NPI 1447260435
  NPD
• Clinical Health Care Associates of New Jersey, PC

  • Hematology & Oncology Physician
  • Cherry Hill, NJ
  • NPI 1669485363
  NPD
• Clinical Healthcare Associates of New Jersey Specialty Practices PC

  • Psychologist
  • Plainsboro, NJ
  • NPI 1235084971
  NPD

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Presbyterian Medical Center of the University of Pennsylvania Health S

  dba UPHS Presbyterian Medical Center

  • General Acute Care Hospital
  • Philadelphia, PA
  • NPI 1245207521
  Care Compare affiliation
• Virtua - West Jersey Health System, Inc.

  • General Acute Care Hospital
  • Voorhees, NJ
  • NPI 1528064409
  Care Compare affiliation

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

{
    "created_epoch": "1453939200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1656460800000",
    "number": "1992163422",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "51 N 39TH STREET",
            "address_2": "CUPP BUILDING 1ST FLOOR",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191042640",
            "telephone_number": "215-662-9801",
            "fax_number": "215-243-3249"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "51 N 39TH STREET",
            "address_2": "CUPP BUILDING 1ST FLOOR",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191042640",
            "telephone_number": "215-662-9801",
            "fax_number": "215-243-3249"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1865 Route 70 East",
            "address_2": "STE 220",
            "address_purpose": "LOCATION",
            "city": "Cherry Hill",
            "state": "NJ",
            "postal_code": "080032013",
            "country_code": "US",
            "telephone_number": "856-429-1519",
            "fax_number": "856-427-0250",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MCKENNON",
        "first_name": "TINA",
        "middle_name": "MARIE",
        "name_prefix": "Mrs.",
        "credential": "CRNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-01-28",
        "last_updated": "2022-06-29",
        "certification_date": "2022-06-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "PA",
            "license": "A0915003",
            "primary": false
        },
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "NJ",
            "license": "26NJ01153900",
            "primary": false
        },
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "PA",
            "license": "SP015746",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "103155510",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Mary McKenna
• Patricia Anne McKenna, MSN,FNP
• Paul Bernard McKenna, M.D.
• Rachel A McKenna, CRNP
• Victoria McKenna, DNP, CRNP, PNP-AC
• McKenzie Sports Therapy LLC
• Ann P. McKenzie, CRNP
• Arlene Gwendolyn McKenzie, PHARM. D.
• Christopher Michael McKenzie, PT, DPT
• Dakota Lawton McKenzie, DDS

• Adult Health Nurse Practitioner in Philadelphia, PA
• Providers in Philadelphia, PA by specialty
• Adult Health Nurse Practitioner in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 29, 2022; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.