Provider Demographics
NPI:1457436255
Name:MCKINNEY, KERRI CASSIDY (PAC)
Entity Type:Individual
Prefix:
First Name:KERRI
Middle Name:CASSIDY
Last Name:MCKINNEY
Suffix:
Gender:F
Credentials:PAC
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 80883
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30608-0883
Mailing Address - Country:US
Mailing Address - Phone:706-549-8114
Mailing Address - Fax:706-549-7558
Practice Address - Street 1:601 BROAD ST SE STE B
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:30501-3718
Practice Address - Country:US
Practice Address - Phone:678-989-1515
Practice Address - Fax:770-868-5650
Is Sole Proprietor?:No
Enumeration Date:2006-10-27
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAQ55976Medicare UPIN
Q55976Medicare UPIN
GA97WCHBTMedicare ID - Type Unspecified