Provider Demographics
NPI:1538652847
Name:MCKINNON, BETHANY (CPM)
Entity Type:Individual
Prefix:
First Name:BETHANY
Middle Name:
Last Name:MCKINNON
Suffix:
Gender:F
Credentials:CPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1803 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:KLAMATH FALLS
Mailing Address - State:OR
Mailing Address - Zip Code:97601-2636
Mailing Address - Country:US
Mailing Address - Phone:907-388-9876
Mailing Address - Fax:
Practice Address - Street 1:1803 MAIN ST
Practice Address - Street 2:
Practice Address - City:KLAMATH FALLS
Practice Address - State:OR
Practice Address - Zip Code:97601-2636
Practice Address - Country:US
Practice Address - Phone:907-388-9876
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-11
Last Update Date:2018-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife