Provider Demographics
NPI:1053423673
Name:MC KENNA, ELAINE LEGATH (MSN, PMHCNS, BC)
Entity type:Individual
Prefix:MRS
First Name:ELAINE
Middle Name:LEGATH
Last Name:MC KENNA
Suffix:
Gender:F
Credentials:MSN, PMHCNS, BC
Other - Prefix:
Other - First Name:M.
Other - Middle Name:ELAINE
Other - Last Name:MC KENNA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSN, PMHCNS
Mailing Address - Street 1:100 WINDING CREEK BLVD
Mailing Address - Street 2:STE 3
Mailing Address - City:MECHANICSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17050-1883
Mailing Address - Country:US
Mailing Address - Phone:717-763-8650
Mailing Address - Fax:717-763-8653
Practice Address - Street 1:3903 HARTZDALE DR
Practice Address - Street 2:SUITE 305
Practice Address - City:CAMP HILL
Practice Address - State:PA
Practice Address - Zip Code:17011-7836
Practice Address - Country:US
Practice Address - Phone:717-763-8650
Practice Address - Fax:717-763-8653
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2018-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN197844L364SP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA021915MVSMedicare UPIN
PA021915MVSMedicare PIN