Provider Demographics
NPI:1164429742
Name:MCKENNA, JOHN I (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:I
Last Name:MCKENNA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:235 E ROWAN AVE
Mailing Address - Street 2:STE 102
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99207-1240
Mailing Address - Country:US
Mailing Address - Phone:509-489-2101
Mailing Address - Fax:509-462-4949
Practice Address - Street 1:235 E ROWAN AVE
Practice Address - Street 2:STE 102
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99207-1240
Practice Address - Country:US
Practice Address - Phone:509-489-2101
Practice Address - Fax:509-462-4949
Is Sole Proprietor?:No
Enumeration Date:2005-06-28
Last Update Date:2008-05-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WAMD00031703207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8155723Medicaid
WA8155723Medicaid
WA1821100132Medicare PIN
F83135Medicare UPIN
WA000349300Medicare PIN