1639332646 NPI number — DR. CHRISTINA MARIE MCKINLEY M.D.

Table of content: DR. CHRISTINA MARIE MCKINLEY M.D. (NPI 1639332646)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1639332646 NPI number — DR. CHRISTINA MARIE MCKINLEY M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MCKINLEY
Provider First Name:
CHRISTINA
Provider Middle Name:
MARIE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
LEAL
Provider Other First Name:
CHRISTINA
Provider Other Middle Name:
MARIE
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.D.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1639332646
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/30/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
71107 HIGHWAY 21
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
COVINGTON
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70433-7243
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
859-238-0021
Provider Business Mailing Address Fax Number:
985-400-5052

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
71107 HIGHWAY 21
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COVINGTON
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70433-7243
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
985-238-0021
Provider Business Practice Location Address Fax Number:
985-400-5052
Provider Enumeration Date:
07/09/2008

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: 207Q00000X , with the licence number:  MD. 203583 , 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: 1181005 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".




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