Provider Demographics
NPI:1720738271
Name:MCKINNEY, LISA MARIE (DO)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:MARIE
Last Name:MCKINNEY
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6407 COUNTRY CLUB DR
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:25705-2045
Mailing Address - Country:US
Mailing Address - Phone:765-993-4860
Mailing Address - Fax:
Practice Address - Street 1:2201 S STERLING ST
Practice Address - Street 2:
Practice Address - City:MORGANTON
Practice Address - State:NC
Practice Address - Zip Code:28655-4044
Practice Address - Country:US
Practice Address - Phone:765-993-4860
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-27
Last Update Date:2022-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program