Provider Demographics
NPI:1962015545
Name:MCKINNEY, VICKY PAULA
Entity Type:Individual
Prefix:
First Name:VICKY
Middle Name:PAULA
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:PO BOX 365
Mailing Address - Street 2:
Mailing Address - City:EAST BANK
Mailing Address - State:WV
Mailing Address - Zip Code:25067-0365
Mailing Address - Country:US
Mailing Address - Phone:304-415-5545
Mailing Address - Fax:
Practice Address - Street 1:239 QUINCY HOLLOW RD
Practice Address - Street 2:
Practice Address - City:BELLE
Practice Address - State:WV
Practice Address - Zip Code:25015-1893
Practice Address - Country:US
Practice Address - Phone:304-415-5545
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-25
Last Update Date:2022-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant