Provider Demographics
NPI:1649943523
Name:MCKINNEY, KELSEY (CNM, WHNP)
Entity type:Individual
Prefix:
First Name:KELSEY
Middle Name:
Last Name:MCKINNEY
Suffix:
Gender:F
Credentials:CNM, WHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1428 RENSSELAER AVE
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32205-8348
Mailing Address - Country:US
Mailing Address - Phone:616-901-2856
Mailing Address - Fax:
Practice Address - Street 1:1307 S PINE AVE
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34471-6543
Practice Address - Country:US
Practice Address - Phone:352-368-2238
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-27
Last Update Date:2021-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11011778176B00000X, 363LW0102X
FLAPRN11011778367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No176B00000XOther Service ProvidersMidwife
No363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health