Provider Demographics
NPI:1497794416
Name:MCKINLEY, NANCY E (MD)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:E
Last Name:MCKINLEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 991
Mailing Address - Street 2:
Mailing Address - City:FAIRMONT
Mailing Address - State:WV
Mailing Address - Zip Code:26555-0991
Mailing Address - Country:US
Mailing Address - Phone:304-367-8901
Mailing Address - Fax:304-368-1518
Practice Address - Street 1:1400 GOOSE RUN RD
Practice Address - Street 2:
Practice Address - City:FAIRMONT
Practice Address - State:WV
Practice Address - Zip Code:26554-1351
Practice Address - Country:US
Practice Address - Phone:304-367-8901
Practice Address - Fax:304-368-1518
Is Sole Proprietor?:No
Enumeration Date:2006-06-05
Last Update Date:2013-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV16429207X00000X
WI28557207X00000X
IN01052528A207X00000X
MN43326207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0097478000Medicaid
4215422Medicare PIN
WV0097478000Medicaid