Provider Demographics
NPI:1417953365
Name:MCKINLEY, JEFFERY W (DO)
Entity Type:Individual
Prefix:DR
First Name:JEFFERY
Middle Name:W
Last Name:MCKINLEY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:810 W COLUMBIA ST
Mailing Address - Street 2:
Mailing Address - City:OBERLIN
Mailing Address - State:KS
Mailing Address - Zip Code:67749-2450
Mailing Address - Country:US
Mailing Address - Phone:785-475-2208
Mailing Address - Fax:785-475-2453
Practice Address - Street 1:810 W COLUMBIA ST
Practice Address - Street 2:
Practice Address - City:OBERLIN
Practice Address - State:KS
Practice Address - Zip Code:67749
Practice Address - Country:US
Practice Address - Phone:785-475-2208
Practice Address - Fax:785-475-2453
Is Sole Proprietor?:No
Enumeration Date:2005-06-24
Last Update Date:2018-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0527824207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS058664OtherBLUE CROSS BLUE SHIELD
KS100368290AMedicaid
080161988OtherRR MEDICARE
666322OtherFIRST GUARD