Provider Demographics
NPI:1407316755
Name:MCKINNEY, KEVIN EDWARD (CRNP)
Entity Type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:EDWARD
Last Name:MCKINNEY
Suffix:
Gender:M
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:202 COVE FORGE RD
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:16693-7138
Mailing Address - Country:US
Mailing Address - Phone:814-626-8663
Mailing Address - Fax:814-832-2345
Practice Address - Street 1:202 COVE FORGE RD
Practice Address - Street 2:
Practice Address - City:WILLIAMSBURG
Practice Address - State:PA
Practice Address - Zip Code:16693-7138
Practice Address - Country:US
Practice Address - Phone:814-626-8663
Practice Address - Fax:814-832-2345
Is Sole Proprietor?:No
Enumeration Date:2019-03-22
Last Update Date:2019-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP020164363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PASP020164OtherPA SBON