MEDICARE: 365MEDMCKENNA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332B00000X	Durable Medical Equipment & Medical Supplies

General Provider Information

NPI Number	:	1134087562
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	365MEDMCKENNA

Provider Business Mailing Address
First Line	:	2212 SE 3RD ST
Second Line	:
City	:	BOYNTON BEACH
State	:	FL
Zip	:	33435-7210
Country	:	US
Telephone Number	:	341-758-2097
Fax Number	:

Provider Business Practice Location Address
First Line	:	2212 SE 3RD ST
Second Line	:
City	:	BOYNTON BEACH
State	:	FL
Zip	:	33435-7210
Country	:	US
Telephone Number	:	341-758-2097
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	TISHA MCKENNA
Credential	:
Telephone Number	:	341-758-2097

Provider Enumeration Date	:	01/14/2026
Last Update Date	:	01/14/2026

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