Provider Demographics
NPI:1417166059
Name:MCKINSTRY, KERRY (AA, BA)
Entity Type:Individual
Prefix:
First Name:KERRY
Middle Name:
Last Name:MCKINSTRY
Suffix:
Gender:F
Credentials:AA, BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:329 ARLINGTON AVE NW
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44708-4703
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:329 ARLINGTON AVE NW
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44708-4703
Practice Address - Country:US
Practice Address - Phone:330-323-8229
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-21
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered171R00000XOther Service ProvidersInterpreter
Not Answered347C00000XTransportation ServicesPrivate Vehicle
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2668948Medicaid
OH7603696OtherODMRDD CONTRACT NUMBER