Provider Demographics
NPI:1821673153
Name:MCKINNEY, FELICIA DIANE
Entity Type:Individual
Prefix:
First Name:FELICIA
Middle Name:DIANE
Last Name:MCKINNEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4504 WESTWOOD PARK DR
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71109-6223
Mailing Address - Country:US
Mailing Address - Phone:318-799-4029
Mailing Address - Fax:
Practice Address - Street 1:4504 WESTWOOD PARK DR
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71109-6223
Practice Address - Country:US
Practice Address - Phone:318-799-4029
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-17
Last Update Date:2021-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider