Provider Demographics
NPI:1952338170
Name:MCKINNEY, KEVIN MOORE (MD)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:MOORE
Last Name:MCKINNEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2660 SCRIPTURE ST STE 120
Mailing Address - Street 2:
Mailing Address - City:DENTON
Mailing Address - State:TX
Mailing Address - Zip Code:76201-4341
Mailing Address - Country:US
Mailing Address - Phone:940-565-1615
Mailing Address - Fax:940-566-0394
Practice Address - Street 1:2660 SCRIPTURE ST STE 120
Practice Address - Street 2:
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76201-4341
Practice Address - Country:US
Practice Address - Phone:940-565-1615
Practice Address - Fax:940-566-0394
Is Sole Proprietor?:No
Enumeration Date:2006-06-26
Last Update Date:2021-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF9802207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX033375901Medicaid
TX033375902Medicaid
TX033375901Medicaid
TX033375902Medicaid
TX8J7062Medicare PIN