Provider Demographics
NPI:1124568779
Name:MCKINNEY, PRINCESS ESTOCIA SIERRA
Entity Type:Individual
Prefix:
First Name:PRINCESS
Middle Name:ESTOCIA SIERRA
Last Name:MCKINNEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:PRINCESS ESTOCIA
Other - Middle Name:S
Other - Last Name:MCKINNEY-KIRK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DOULA
Mailing Address - Street 1:3707 E SOUTHERN AVE
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85206-2569
Mailing Address - Country:US
Mailing Address - Phone:844-692-3554
Mailing Address - Fax:
Practice Address - Street 1:3707 E SOUTHERN AVE STE 1013
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85206-6201
Practice Address - Country:US
Practice Address - Phone:844-692-3554
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-01
Last Update Date:2022-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula