Provider Demographics
NPI:1407528011
Name:PINKNEY, KEYAIRAH
Entity Type:Individual
Prefix:
First Name:KEYAIRAH
Middle Name:
Last Name:PINKNEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:MISSION AUTISM CLINIC 9 BANKS AVENUE
Mailing Address - Street 2:
Mailing Address - City:MCADOO
Mailing Address - State:PA
Mailing Address - Zip Code:18237-2508
Mailing Address - Country:US
Mailing Address - Phone:888-726-4774
Mailing Address - Fax:570-360-5112
Practice Address - Street 1:200 BENT CREEK BLVD
Practice Address - Street 2:
Practice Address - City:MECHANICSBURG
Practice Address - State:PA
Practice Address - Zip Code:17050-1938
Practice Address - Country:US
Practice Address - Phone:717-460-0878
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-01
Last Update Date:2021-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1538790720Medicaid