Provider Demographics
NPI:1063839165
Name:MCKINNEY, SHELIA YVONNE
Entity Type:Individual
Prefix:
First Name:SHELIA
Middle Name:YVONNE
Last Name:MCKINNEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 24446
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76124-1446
Mailing Address - Country:US
Mailing Address - Phone:817-988-7602
Mailing Address - Fax:817-413-5572
Practice Address - Street 1:4623 MILLER AVE STE B
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76119-5064
Practice Address - Country:US
Practice Address - Phone:817-988-7602
Practice Address - Fax:817-413-5572
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-26
Last Update Date:2014-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX171W00000X, 253J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253J00000XAgenciesFoster Care Agency
No171W00000XOther Service ProvidersContractor