Provider Demographics
NPI:1083376594
Name:CHRISTINA MCKINLEY
Entity Type:Organization
Organization Name:CHRISTINA MCKINLEY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINA
Authorized Official - Middle Name:M
Authorized Official - Last Name:MCKINLEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:504-232-5695
Mailing Address - Street 1:211 CHURCHILL DOWNS DR
Mailing Address - Street 2:
Mailing Address - City:BUSH
Mailing Address - State:LA
Mailing Address - Zip Code:70431-4504
Mailing Address - Country:US
Mailing Address - Phone:504-232-5695
Mailing Address - Fax:985-781-0548
Practice Address - Street 1:71107 HIGHWAY 21
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:LA
Practice Address - Zip Code:70433-7243
Practice Address - Country:US
Practice Address - Phone:985-781-0548
Practice Address - Fax:985-781-4319
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-12
Last Update Date:2021-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult MedicineGroup - Multi-Specialty