Provider Demographics
NPI:1073705281
Name:MCKINNEY, LLOYD MARK (PA)
Entity Type:Individual
Prefix:
First Name:LLOYD
Middle Name:MARK
Last Name:MCKINNEY
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5210 CLEVELAND BLVD
Mailing Address - Street 2:STE 140-214
Mailing Address - City:CALDWELL
Mailing Address - State:ID
Mailing Address - Zip Code:83607-1796
Mailing Address - Country:US
Mailing Address - Phone:541-231-4627
Mailing Address - Fax:
Practice Address - Street 1:436 5TH & TED STEVENS WAY
Practice Address - Street 2:
Practice Address - City:KOTZEBUE
Practice Address - State:AK
Practice Address - Zip Code:99752-0043
Practice Address - Country:US
Practice Address - Phone:907-442-3321
Practice Address - Fax:907-442-7250
Is Sole Proprietor?:No
Enumeration Date:2007-08-11
Last Update Date:2011-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363A00000X
IDPA735363A00000X
MDC04190363A00000X
AK2160363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKHS19IPMedicaid
AKHS19OPMedicaid
MD177266Y9QMedicare PIN
AKHS19OPMedicaid
AKTEZ042Medicare PIN