Provider Demographics
NPI:1790702447
Name:MCKINNEY, BAIN L (NP)
Entity Type:Individual
Prefix:
First Name:BAIN
Middle Name:L
Last Name:MCKINNEY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3175 S CONGRESS AVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:PALM SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33461-2500
Mailing Address - Country:US
Mailing Address - Phone:561-434-4261
Mailing Address - Fax:561-434-5039
Practice Address - Street 1:3175 S CONGRESS AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:PALM SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33461-2500
Practice Address - Country:US
Practice Address - Phone:561-434-4261
Practice Address - Fax:561-434-5039
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2010-06-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FL3269532363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily