Provider Demographics
NPI:1942479316
Name:MCKINNEY, MELANIE RENE (MS, CNS-BC)
Entity Type:Individual
Prefix:MISS
First Name:MELANIE
Middle Name:RENE
Last Name:MCKINNEY
Suffix:
Gender:F
Credentials:MS, CNS-BC
Other - Prefix:
Other - First Name:MELANIE
Other - Middle Name:RENE
Other - Last Name:FUGITT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1923S UTICA AVE
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74104-6520
Mailing Address - Country:US
Mailing Address - Phone:918-744-2630
Mailing Address - Fax:918-744-2946
Practice Address - Street 1:1923S UTICA AVE
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74104-6520
Practice Address - Country:US
Practice Address - Phone:918-748-7650
Practice Address - Fax:918-403-6341
Is Sole Proprietor?:No
Enumeration Date:2008-02-29
Last Update Date:2018-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKR0079630364SA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SA2200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200193540AMedicaid
OKOK400424Medicare PIN