Provider Demographics
NPI:1184922395
Name:MCKINNEY, OLVIA A (NP)
Entity type:Individual
Prefix:MRS
First Name:OLVIA
Middle Name:A
Last Name:MCKINNEY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7830 JOHNSON RD
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46250-2075
Mailing Address - Country:US
Mailing Address - Phone:317-396-0683
Mailing Address - Fax:317-396-0687
Practice Address - Street 1:7830 JOHNSON RD
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46250-2075
Practice Address - Country:US
Practice Address - Phone:317-396-0683
Practice Address - Fax:317-396-0687
Is Sole Proprietor?:No
Enumeration Date:2011-03-11
Last Update Date:2014-07-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28174669A163W00000X
IN71004839A363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse