Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
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Jalisa Jonique McCullough, PMHNP

Individual provider Psychiatric/Mental Health Nurse Practitioner · NPI 1730702077

Jalisa Jonique McCullough, PMHNP is a Nurse Practitioner in Rochester, New York. Qualified in 2020, 6 years ago. Practices with Athenapsych LLC, an 8-clinician group and accepts Medicare assignment. Licensed in New York.

Years since qualifying
6
Licensed in
NY
In the registry since
2020
What do these letters mean?
PMHNP — Psychiatric-Mental Health Nurse Practitioner
A nurse practitioner specialising in mental health, able to prescribe psychiatric medication.

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Practice location Address checks out

300 Crittenden Boulevard Box Psych
Rochester, NY 14642-0001
Phone: (585) 275-3592
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Psychiatric/Mental Health Nurse Practitioner (primary) Taxonomy 363LP0808X · Licence 402978 (NY)

Record details

NPI number1730702077
Entity typeIndividual (Type 1)
GenderFemale
Credentials PMHNP
Sole proprietorYes
NPI enumeratedMay 21, 2020
Last updated in NPPESJuly 3, 2023
Certification dateMay 21, 2020

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyNURSE PRACTITIONER
Medical schoolOTHER
Graduated 2020 (6 years in practice)
Group practice Athenapsych Llc — 8 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

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