Provider Demographics
NPI:1942838016
Name:MCKINNEY, LAUREN M (DO)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:M
Last Name:MCKINNEY
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3412 CUTSHAW AVE
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23230-5014
Mailing Address - Country:US
Mailing Address - Phone:703-408-3948
Mailing Address - Fax:
Practice Address - Street 1:656 INDEPENDENCE PKWY STE 200
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23320-5213
Practice Address - Country:US
Practice Address - Phone:757-668-5126
Practice Address - Fax:757-410-3631
Is Sole Proprietor?:No
Enumeration Date:2020-04-01
Last Update Date:2023-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
VA0102207790208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program