Provider Demographics
NPI:1093007155
Name:MACKINNON, KARYNN ANDREA (LMP)
Entity Type:Individual
Prefix:MS
First Name:KARYNN
Middle Name:ANDREA
Last Name:MACKINNON
Suffix:
Gender:F
Credentials:LMP
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Mailing Address - Street 1:4820 NE HAZEL DELL AVE
Mailing Address - Street 2:233
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98663-3803
Mailing Address - Country:US
Mailing Address - Phone:503-764-8660
Mailing Address - Fax:360-953-8307
Practice Address - Street 1:1906 BROADWAY ST
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98663-3325
Practice Address - Country:US
Practice Address - Phone:503-764-8660
Practice Address - Fax:360-953-8307
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-09
Last Update Date:2013-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60212905225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist