Provider Demographics
NPI:1225287121
Name:MCKINLEY, SIDNEY M (FNP-BC)
Entity Type:Individual
Prefix:
First Name:SIDNEY
Middle Name:M
Last Name:MCKINLEY
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:SIDNEY
Other - Middle Name:TURNER
Other - Last Name:MCKINLEY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1911 JACKSON ST
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71202-2531
Mailing Address - Country:US
Mailing Address - Phone:318-615-0015
Mailing Address - Fax:318-615-0015
Practice Address - Street 1:1911 JACKSON ST
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71202-2531
Practice Address - Country:US
Practice Address - Phone:318-615-0015
Practice Address - Fax:318-330-7648
Is Sole Proprietor?:No
Enumeration Date:2008-09-16
Last Update Date:2024-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA05599363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA020914OtherLOUISIANA STATE BOARD OF NURSING PERSCRIPTIVE AUTHORITY
LA096467OtherRN
LA05599OtherADVANCED PRACTICE
LA1348848Medicaid