Provider Demographics
NPI:1295718336
Name:MACKINNEY, A. CLINTON (MD, MS)
Entity type:Individual
Prefix:DR
First Name:A.
Middle Name:CLINTON
Last Name:MACKINNEY
Suffix:
Gender:M
Credentials:MD, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33921 N 91ST AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT JOSEPH
Mailing Address - State:MN
Mailing Address - Zip Code:56374
Mailing Address - Country:US
Mailing Address - Phone:320-363-8150
Mailing Address - Fax:
Practice Address - Street 1:815 2ND ST SE
Practice Address - Street 2:
Practice Address - City:LITTLE FALLS
Practice Address - State:MN
Practice Address - Zip Code:56345-3505
Practice Address - Country:US
Practice Address - Phone:320-632-5441
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN27914207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine