Provider Demographics
NPI:1851381255
Name:MCKINNIS, VALERIE SUE (MD)
Entity Type:Individual
Prefix:DR
First Name:VALERIE
Middle Name:SUE
Last Name:MCKINNIS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:VALERIE
Other - Middle Name:SUE
Other - Last Name:BAUMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1010 THREE SPRINGS BLVD
Mailing Address - Street 2:
Mailing Address - City:DURANGO
Mailing Address - State:CO
Mailing Address - Zip Code:81301-8296
Mailing Address - Country:US
Mailing Address - Phone:970-764-3352
Mailing Address - Fax:970-764-3375
Practice Address - Street 1:1010 THREE SPRINGS BLVD
Practice Address - Street 2:
Practice Address - City:DURANGO
Practice Address - State:CO
Practice Address - Zip Code:81301-8296
Practice Address - Country:US
Practice Address - Phone:970-764-3352
Practice Address - Fax:970-764-3375
Is Sole Proprietor?:No
Enumeration Date:2005-10-26
Last Update Date:2022-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO40492207Q00000X
CODR.0040492208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM65474562Medicaid
AZ810524Medicaid
CO48138746Medicaid
NM65474562Medicaid
320059Medicare Oscar/Certification
8HBR48Medicare PIN