Provider Demographics
NPI:1780871459
Name:MCKINNEY, CASEY ELIZABETH (PA C)
Entity type:Individual
Prefix:MRS
First Name:CASEY
Middle Name:ELIZABETH
Last Name:MCKINNEY
Suffix:
Gender:F
Credentials:PA C
Other - Prefix:MRS
Other - First Name:CASEY
Other - Middle Name:ELIZABETH
Other - Last Name:MCKINNEY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PA-C
Mailing Address - Street 1:1520 EVERGREEN PKWY
Mailing Address - Street 2:
Mailing Address - City:EVERGREEN
Mailing Address - State:CO
Mailing Address - Zip Code:80439-7848
Mailing Address - Country:US
Mailing Address - Phone:303-674-2273
Mailing Address - Fax:303-670-2160
Practice Address - Street 1:1520 EVERGREEN PKWY
Practice Address - Street 2:
Practice Address - City:EVERGREEN
Practice Address - State:CO
Practice Address - Zip Code:80439-7848
Practice Address - Country:US
Practice Address - Phone:303-674-2273
Practice Address - Fax:303-670-2160
Is Sole Proprietor?:No
Enumeration Date:2007-09-26
Last Update Date:2007-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2473363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical