Provider Demographics
NPI:1902531650
Name:COUNTRYMAN, TAYLOR JEANNINE (PMHNP)
Entity Type:Individual
Prefix:MS
First Name:TAYLOR
Middle Name:JEANNINE
Last Name:COUNTRYMAN
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:524 QUEENS HWY
Mailing Address - Street 2:
Mailing Address - City:ACCORD
Mailing Address - State:NY
Mailing Address - Zip Code:12404-6106
Mailing Address - Country:US
Mailing Address - Phone:845-702-7193
Mailing Address - Fax:
Practice Address - Street 1:1 FAMILY PRACTICE DR
Practice Address - Street 2:
Practice Address - City:KINGSTON
Practice Address - State:NY
Practice Address - Zip Code:12401-6449
Practice Address - Country:US
Practice Address - Phone:845-338-2562
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-18
Last Update Date:2022-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY404243363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health