National Provider Identifier
Jalisa Jonique McCullough, PMHNP
Jalisa Jonique McCullough, PMHNP is listed in the NPPES registry with a primary specialty of Psychiatric/Mental Health Nurse Practitioner in Rochester, NY and a listed phone number of (585) 275-3592.
Profile Overview
- NPI
- 1730702077
- Provider Type
- Individual
- Primary Specialty
- Psychiatric/Mental Health Nurse Practitioner
- Enumeration Date
- May 21, 2020
- Last Updated
- July 03, 2023
Practice Location
- 300 Crittenden Boulevard Box Psych
- Rochester, NY 14642-0001
Phone: (585) 275-3592
Mailing Address
- 604 Suburban Ct Apt 2
- Rochester, NY 14620-3837
Specialties
- Psychiatric/Mental Health Nurse Practitioner (363LP0808X)
Endpoints
- jmccullough81414@direct.urmc.rochester.edu
Direct Messaging Address | Direct | Other | Rochester, NY 14642
Full Record
- NPI
- 1730702077
- Entity Type
- Individual
- Last Name
- McCullough
- First Name
- Jalisa
- Middle Name
- Jonique
- Credential
- PMHNP
- Mailing Street Address
- 604 Suburban Ct Apt 2
- Mailing City
- Rochester
- Mailing State
- NY
- Mailing ZIP Code
- 14620-3837
- Mailing Country
- US
- Mailing Phone
- (585) 309-2363
- Practice Street Address
- 300 Crittenden Boulevard Box Psych
- Practice City
- Rochester
- Practice State
- NY
- Practice ZIP Code
- 14642-0001
- Practice Country
- US
- Practice Phone
- (585) 275-3592
- Enumeration Date
- May 21, 2020
- Last Updated
- July 03, 2023
- Sex
- Female
- Sole Proprietor
- Yes
- Certification Date
- May 21, 2020
- updated_by_file
- npidata_pfile_20050523-20260308.csv
- Taxonomies
- Psychiatric/Mental Health Nurse Practitioner (363LP0808X)