Provider Demographics
NPI:1831734193
Name:MCKINNEY, TOMMIE JO (QMHP-CS)
Entity type:Individual
Prefix:
First Name:TOMMIE
Middle Name:JO
Last Name:MCKINNEY
Suffix:
Gender:F
Credentials:QMHP-CS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:403 E WOODLAND RD
Mailing Address - Street 2:
Mailing Address - City:MARSHALL
Mailing Address - State:TX
Mailing Address - Zip Code:75672-7243
Mailing Address - Country:US
Mailing Address - Phone:903-387-7777
Mailing Address - Fax:
Practice Address - Street 1:403 E WOODLAND RD
Practice Address - Street 2:
Practice Address - City:MARSHALL
Practice Address - State:TX
Practice Address - Zip Code:75672-7243
Practice Address - Country:US
Practice Address - Phone:903-387-7777
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-11
Last Update Date:2019-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker