1225287121 NPI number — SIDNEY M MCKINLEY FNP-BC

Table of content: SIDNEY M MCKINLEY FNP-BC (NPI 1225287121)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1225287121 NPI number — SIDNEY M MCKINLEY FNP-BC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MCKINLEY
Provider First Name:
SIDNEY
Provider Middle Name:
M
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
FNP-BC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MCKINLEY
Provider Other First Name:
SIDNEY
Provider Other Middle Name:
TURNER
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1225287121
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/19/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1911 JACKSON ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MONROE
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
71202-2531
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
318-615-0015
Provider Business Mailing Address Fax Number:
318-615-0015

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1911 JACKSON ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MONROE
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
71202-2531
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
318-615-0015
Provider Business Practice Location Address Fax Number:
318-330-7648
Provider Enumeration Date:
09/16/2008

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: 363LF0000X , with the licence number:  05599 , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 020914 . This is a "LOUISIANA STATE BOARD OF NURSING PERSCRIPTIVE AUTHORITY" identifier , issued by the state of ( LA ) . This identifiers is of the category "OTHER".
  • Identifier: 096467 . This is a "RN" identifier , issued by the state of ( LA ) . This identifiers is of the category "OTHER".
  • Identifier: 05599 . This is a "ADVANCED PRACTICE" identifier , issued by the state of ( LA ) . This identifiers is of the category "OTHER".
  • Identifier: 1348848 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".




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