Provider Demographics
NPI:1194473637
Name:MCKINNEY, BENJAMIN (PA)
Entity Type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:
Last Name:MCKINNEY
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4660 ATHENS WALNUT HILL PIKE
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40515
Mailing Address - Country:US
Mailing Address - Phone:502-232-2371
Mailing Address - Fax:
Practice Address - Street 1:4660 ATHENS WALNUT HILL PIKE
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40515
Practice Address - Country:US
Practice Address - Phone:502-232-2371
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-14
Last Update Date:2023-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant