Provider Demographics
NPI:1689127854
Name:MCKINNEY, MARANDA R (FNP)
Entity Type:Individual
Prefix:
First Name:MARANDA
Middle Name:R
Last Name:MCKINNEY
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2186 W US HIGHWAY 40
Mailing Address - Street 2:
Mailing Address - City:BRAZIL
Mailing Address - State:IN
Mailing Address - Zip Code:47834-7201
Mailing Address - Country:US
Mailing Address - Phone:812-878-8223
Mailing Address - Fax:
Practice Address - Street 1:2186 W US HIGHWAY 40
Practice Address - Street 2:
Practice Address - City:BRAZIL
Practice Address - State:IN
Practice Address - Zip Code:47834-7201
Practice Address - Country:US
Practice Address - Phone:812-878-8223
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-25
Last Update Date:2024-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71006518A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily