1003893603 NPI number — DENISE LYNN MCKINNEY CRNP

Table of content: DENISE LYNN MCKINNEY CRNP (NPI 1003893603)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1003893603 NPI number — DENISE LYNN MCKINNEY CRNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MCKINNEY
Provider First Name:
DENISE
Provider Middle Name:
LYNN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
CRNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1003893603
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2480 LLEWELLYN AVE
Provider Second Line Business Mailing Address:
KIMBROUGH AMBULATORY CARE CENTER ATTN' MCXR-CR
Provider Business Mailing Address City Name:
FT MEADE
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20755-5800
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
301-677-8270
Provider Business Mailing Address Fax Number:
310-677-8176

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2501 OAKINGTON ST
Provider Second Line Business Practice Location Address:
KIRK ARMY HEALTH CLINIC
Provider Business Practice Location Address City Name:
APG
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21005-5131
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-278-1928
Provider Business Practice Location Address Fax Number:
410-278-1944
Provider Enumeration Date:
12/27/2005

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LP0200X , with the licence number:  R058407 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)