Provider Demographics
NPI:1942947353
Name:MCKINLEY, LEAH EMERALD
Entity Type:Individual
Prefix:MRS
First Name:LEAH
Middle Name:EMERALD
Last Name:MCKINLEY
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 1:7330 SIMMS LANDING RD
Mailing Address - Street 2:
Mailing Address - City:PORT TOBACCO
Mailing Address - State:MD
Mailing Address - Zip Code:20677-3148
Mailing Address - Country:US
Mailing Address - Phone:240-640-8765
Mailing Address - Fax:
Practice Address - Street 1:6 SAINT MARYS AVE STE 102
Practice Address - Street 2:
Practice Address - City:LA PLATA
Practice Address - State:MD
Practice Address - Zip Code:20646-4040
Practice Address - Country:US
Practice Address - Phone:240-349-2932
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-17
Last Update Date:2022-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD246Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246Z00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, Other