Healthcare Provider Details

I. General information

NPI: 1891322392
Provider Name (Legal Business Name): ANNA MCKINSEY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/25/2020
Last Update Date: 06/23/2023
Certification Date: 06/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

335 E AVENUE I
LANCASTER CA
93535-1916
US

IV. Provider business mailing address

1 EDGEDALE DR
ASHEVILLE NC
28804-1701
US

V. Phone/Fax

Practice location:
  • Phone: 661-471-4000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number184038
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: