Provider Demographics
NPI:1598204711
Name:MCKINNEY, DANIELLE (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:DANIELLE
Middle Name:
Last Name:MCKINNEY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:DANIELLE
Other - Middle Name:
Other - Last Name:KERSHNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3765 E. BLUE LUPINE DR. STE D
Mailing Address - Street 2:
Mailing Address - City:WASILLA
Mailing Address - State:AK
Mailing Address - Zip Code:99654
Mailing Address - Country:US
Mailing Address - Phone:907-707-1671
Mailing Address - Fax:907-707-1675
Practice Address - Street 1:3765 E. BLUE LUPINE DR. STE D
Practice Address - Street 2:
Practice Address - City:WASILLA
Practice Address - State:AK
Practice Address - Zip Code:99654
Practice Address - Country:US
Practice Address - Phone:907-707-1671
Practice Address - Fax:907-707-1675
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-21
Last Update Date:2022-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOA004070363AM0700X
PAMA058876363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical