Provider Demographics
NPI:1275915589
Name:MCKINNEY, JENNIFER LEE (RN, WHNP-BC, IBCLC)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:LEE
Last Name:MCKINNEY
Suffix:
Gender:F
Credentials:RN, WHNP-BC, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2270 SPEAR POINT TRL
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30062-2548
Mailing Address - Country:US
Mailing Address - Phone:404-731-9310
Mailing Address - Fax:
Practice Address - Street 1:2270 SPEAR POINT TRL
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30062-2548
Practice Address - Country:US
Practice Address - Phone:404-731-9310
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-23
Last Update Date:2015-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA179661163WW0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WW0101XNursing Service ProvidersRegistered NurseWomen's Health Care, Ambulatory