Provider Demographics
NPI:1700441136
Name:MCKINNEY, MIKA LARAY (CSFA)
Entity Type:Individual
Prefix:MISS
First Name:MIKA
Middle Name:LARAY
Last Name:MCKINNEY
Suffix:
Gender:F
Credentials:CSFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:496 N CORAL CANYON LOOP APT 200
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72704-6297
Mailing Address - Country:US
Mailing Address - Phone:918-774-7255
Mailing Address - Fax:
Practice Address - Street 1:3733 N BUSINESS DR STE 101
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72703-5286
Practice Address - Country:US
Practice Address - Phone:479-443-5476
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-01
Last Update Date:2019-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant