Healthcare Provider Details

I. General information

NPI: 1295007342
Provider Name (Legal Business Name): TERESA BETH MCKINNEY P.A.-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/06/2012
Last Update Date: 11/03/2025
Certification Date: 11/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 SE PLAZA AVE STE 5
BENTONVILLE AR
72712-5473
US

IV. Provider business mailing address

PO BOX 315
CHOUTEAU OK
74337-0315
US

V. Phone/Fax

Practice location:
  • Phone: 479-876-8550
  • Fax: 479-208-4266
Mailing address:
  • Phone: 918-476-6030
  • Fax: 918-476-6038

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number3046
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA464
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: