Provider Demographics
NPI:1194836478
Name:MCKINNEY, LESLIE CHERYL (MD)
Entity Type:Individual
Prefix:
First Name:LESLIE
Middle Name:CHERYL
Last Name:MCKINNEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:212 ASHVILLE AVE
Mailing Address - Street 2:SUITE 10
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27511
Mailing Address - Country:US
Mailing Address - Phone:919-859-1136
Mailing Address - Fax:919-859-4240
Practice Address - Street 1:212 ASHVILLE AVE
Practice Address - Street 2:SUITE 10
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27511
Practice Address - Country:US
Practice Address - Phone:919-859-1136
Practice Address - Fax:919-859-4240
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2012-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0032206207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
336395OtherMAMSI GROUP
NC8057161Medicaid
NC89011P3Medicaid
562149430OtherUNITED GROUP
67161OtherBCBS PROVIDER
6655498OtherUNITED PROVIDER
4285030OtherAETNA INDIVIDUAL
7441170OtherAETNA GROUP
96422OtherMEDCOST PROVIDER
00-32206OtherLICENSE
011P3OtherBCBS GROUP
3131308OtherCIGNA PROVIDER AND GROUP
562149430OtherMEDCOST GROUP
3131308OtherCIGNA PROVIDER AND GROUP
00-32206OtherLICENSE
96422OtherMEDCOST PROVIDER
336395OtherMAMSI GROUP
7441170OtherAETNA GROUP