Provider Demographics
NPI:1013796291
Name:MCKINNEY, KRISSHONDA D (FNP-C)
Entity type:Individual
Prefix:
First Name:KRISSHONDA
Middle Name:D
Last Name:MCKINNEY
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1323 S CENTER RD
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48638-6323
Mailing Address - Country:US
Mailing Address - Phone:989-798-5833
Mailing Address - Fax:
Practice Address - Street 1:3720 KATALIN CT
Practice Address - Street 2:
Practice Address - City:BAY CITY
Practice Address - State:MI
Practice Address - Zip Code:48706-2106
Practice Address - Country:US
Practice Address - Phone:989-686-2800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-26
Last Update Date:2023-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704340305207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine