Provider Demographics
NPI:1194041574
Name:MCKINNEY-WHITSON, VENESHIA NACOLE' (MD)
Entity Type:Individual
Prefix:
First Name:VENESHIA
Middle Name:NACOLE'
Last Name:MCKINNEY-WHITSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:VENESHIA
Other - Middle Name:NACOLE'
Other - Last Name:MCKINNEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1121 E NORTH AVE
Mailing Address - Street 2:COLUMBIA-ST MARY'S FAMILY MEDICINE
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53212-3515
Mailing Address - Country:US
Mailing Address - Phone:414-267-6502
Mailing Address - Fax:414-267-3892
Practice Address - Street 1:1121 E NORTH AVE
Practice Address - Street 2:COLUMBIA-ST MARY'S FAMILY MEDICINE
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53212-3515
Practice Address - Country:US
Practice Address - Phone:414-267-6502
Practice Address - Fax:414-267-3892
Is Sole Proprietor?:No
Enumeration Date:2010-04-11
Last Update Date:2013-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI57604207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1194041574Medicaid