Provider Demographics
NPI:1639916174
Name:MCKINNEY, KEAGAN
Entity type:Individual
Prefix:
First Name:KEAGAN
Middle Name:
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 1:2402 NW 195TH PL
Mailing Address - Street 2:
Mailing Address - City:SHORELINE
Mailing Address - State:WA
Mailing Address - Zip Code:98177-2932
Mailing Address - Country:US
Mailing Address - Phone:206-364-3777
Mailing Address - Fax:206-364-3999
Practice Address - Street 1:1909 214TH ST SE STE 204
Practice Address - Street 2:
Practice Address - City:BOTHELL
Practice Address - State:WA
Practice Address - Zip Code:98021-4415
Practice Address - Country:US
Practice Address - Phone:425-219-4788
Practice Address - Fax:425-219-4790
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-11
Last Update Date:2024-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker