Provider Demographics
NPI:1003516543
Name:MCKINLEY, CHANELLE (BHS, MPA)
Entity Type:Individual
Prefix:
First Name:CHANELLE
Middle Name:
Last Name:MCKINLEY
Suffix:
Gender:F
Credentials:BHS, MPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8160 PARALLEL PKWY STE 203
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:KS
Mailing Address - Zip Code:66112-2068
Mailing Address - Country:US
Mailing Address - Phone:816-288-5367
Mailing Address - Fax:
Practice Address - Street 1:8160 PARALLEL PKWY STE 203
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:KS
Practice Address - Zip Code:66112-2068
Practice Address - Country:US
Practice Address - Phone:816-288-5367
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-03
Last Update Date:2023-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KST014174253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS30004866170001Medicaid