Provider Demographics
NPI:1659049062
Name:MCKINNEY, IVAN
Entity Type:Individual
Prefix:
First Name:IVAN
Middle Name:
Last Name:MCKINNEY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:727 VALEMONT DR
Mailing Address - Street 2:
Mailing Address - City:GADSDEN
Mailing Address - State:AL
Mailing Address - Zip Code:35901-6240
Mailing Address - Country:US
Mailing Address - Phone:256-393-6543
Mailing Address - Fax:
Practice Address - Street 1:727 VALEMONT DR
Practice Address - Street 2:
Practice Address - City:GADSDEN
Practice Address - State:AL
Practice Address - Zip Code:35901-6240
Practice Address - Country:US
Practice Address - Phone:256-393-6543
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-31
Last Update Date:2021-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program