Provider Demographics
NPI:1407221484
Name:MCKINNEY, SONYA (APRN)
Entity Type:Individual
Prefix:MRS
First Name:SONYA
Middle Name:
Last Name:MCKINNEY
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:209 CROSSROADS PL
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:IL
Mailing Address - Zip Code:62864-6545
Mailing Address - Country:US
Mailing Address - Phone:618-244-6222
Mailing Address - Fax:618-244-7299
Practice Address - Street 1:209 CROSSROADS PL
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:IL
Practice Address - Zip Code:62864-6545
Practice Address - Country:US
Practice Address - Phone:618-244-6222
Practice Address - Fax:618-244-7299
Is Sole Proprietor?:No
Enumeration Date:2015-12-02
Last Update Date:2022-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.013632363L00000X
IL209013632363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily