Provider Demographics
NPI:1538704283
Name:MCKINLEY, KASEY ANDREA
Entity Type:Individual
Prefix:
First Name:KASEY
Middle Name:ANDREA
Last Name:MCKINLEY
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 1:2819 BACO NOIR DR SW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87121-5394
Mailing Address - Country:US
Mailing Address - Phone:505-270-1743
Mailing Address - Fax:
Practice Address - Street 1:2819 BACO NOIR DR SW
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87121-5394
Practice Address - Country:US
Practice Address - Phone:505-270-1743
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-16
Last Update Date:2019-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician