Provider Demographics
NPI:1932379658
Name:MELISSA A. MCKINNEY, D.O., P.L.L.C.
Entity Type:Organization
Organization Name:MELISSA A. MCKINNEY, D.O., P.L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:A
Authorized Official - Last Name:MCKINNEY
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:928-592-9140
Mailing Address - Street 1:2370 W HWY 89A #11 PMB 412
Mailing Address - Street 2:
Mailing Address - City:SEDONA
Mailing Address - State:AZ
Mailing Address - Zip Code:86336-5341
Mailing Address - Country:US
Mailing Address - Phone:928-592-9140
Mailing Address - Fax:928-592-9144
Practice Address - Street 1:4283 PIMA WAY
Practice Address - Street 2:
Practice Address - City:LAKE MONTEZUMA
Practice Address - State:AZ
Practice Address - Zip Code:86342-5087
Practice Address - Country:US
Practice Address - Phone:928-592-9140
Practice Address - Fax:928-592-9144
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-10
Last Update Date:2008-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4057261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ104516OtherMEDICARE GROUP NUMBER