Provider Demographics
NPI:1558033241
Name:MCMINN, KARINA AYDEE
Entity Type:Individual
Prefix:
First Name:KARINA
Middle Name:AYDEE
Last Name:MCMINN
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 1:1606 SIERRA DR
Mailing Address - Street 2:
Mailing Address - City:BAYTOWN
Mailing Address - State:TX
Mailing Address - Zip Code:77521-3529
Mailing Address - Country:US
Mailing Address - Phone:281-515-0014
Mailing Address - Fax:
Practice Address - Street 1:5627 LAUREL CREEK WAY
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77017-6838
Practice Address - Country:US
Practice Address - Phone:281-515-0014
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-30
Last Update Date:2022-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX25879079374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374U00000XNursing Service Related ProvidersHome Health AideGroup - Single Specialty