MEDICARE: DR. STEPHEN M MCKINLEY OD

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	152W00000X	Optometrist	1676DT	KY
2	152W00000X	Optometrist	2659	TN

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
4	DG5893	OTHER	KY	RAILROAD MEDICARE GROUP # FOR WILLIAMSBURG
9	PO0760685	OTHER		RAILROAD MEDICARE FOR JELLICO
10	P00443168	OTHER	KY	RAILROAD MEDICARE(PTAN)

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	01177961	OTHER		AMERIGROUP
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
7	4163597	OTHER	TN	TENNCARE/BLUECARE/BCBSTN
8	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
11	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
12	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
13	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1902903511
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STEPHEN M MCKINLEY OD

Provider Business Mailing Address
First Line	:	PO BOX 306
Second Line	:
City	:	FERGUSON
State	:	KY
Zip	:	42533-0306
Country	:	US
Telephone Number	:	606-492-2211
Fax Number	:	606-676-0873

Provider Business Practice Location Address
First Line	:	86 MEDICAL LN
Second Line	:
City	:	WHITLEY CITY
State	:	KY
Zip	:	42653-4216
Country	:	US
Telephone Number	:	606-376-5258
Fax Number	:	606-376-2045

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/19/2006
Last Update Date	:	05/11/2026

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