Provider Demographics
NPI:1598133324
Name:MCKINNEY, MELINDA ROBIN
Entity Type:Individual
Prefix:
First Name:MELINDA
Middle Name:ROBIN
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 1:4904 E TRAILS END DR
Mailing Address - Street 2:APT A
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86004-2756
Mailing Address - Country:US
Mailing Address - Phone:928-600-3643
Mailing Address - Fax:
Practice Address - Street 1:4904 E TRAILS END DR
Practice Address - Street 2:APT A
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86004-2756
Practice Address - Country:US
Practice Address - Phone:928-600-3643
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-10
Last Update Date:2015-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other