Provider Demographics
NPI:1710163779
Name:MCKINLEY, ROSLYN LANETT (SERVICE PROVIDER)
Entity Type:Individual
Prefix:MRS
First Name:ROSLYN
Middle Name:LANETT
Last Name:MCKINLEY
Suffix:
Gender:F
Credentials:SERVICE PROVIDER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2108 ELLING DR
Mailing Address - Street 2:
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76705-2717
Mailing Address - Country:US
Mailing Address - Phone:254-799-3200
Mailing Address - Fax:
Practice Address - Street 1:2108 ELLING DR
Practice Address - Street 2:
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76705-2717
Practice Address - Country:US
Practice Address - Phone:254-799-3200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-21
Last Update Date:2008-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor