Provider Demographics
NPI:1558793018
Name:MCKINNEY, PAULA JEFFRIES
Entity Type:Individual
Prefix:MRS
First Name:PAULA
Middle Name:JEFFRIES
Last Name:MCKINNEY
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 1:4404 PEACEFORD GLEN DR
Mailing Address - Street 2:
Mailing Address - City:HIGH POINT
Mailing Address - State:NC
Mailing Address - Zip Code:27265-8229
Mailing Address - Country:US
Mailing Address - Phone:336-841-5546
Mailing Address - Fax:
Practice Address - Street 1:4700 PIEDMONT PKWY
Practice Address - Street 2:
Practice Address - City:JAMESTOWN
Practice Address - State:NC
Practice Address - Zip Code:27282-7505
Practice Address - Country:US
Practice Address - Phone:336-852-9464
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-06
Last Update Date:2013-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC100093183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist