Healthcare Provider Details

I. General information

NPI: 1801679212
Provider Name (Legal Business Name): VERNA MCKINNEY MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/17/2023
Last Update Date: 09/27/2023
Certification Date: 09/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3840 ROSIN CT STE 100
SACRAMENTO CA
95834-1645
US

IV. Provider business mailing address

1300 FLORIN RD APT 6
SACRAMENTO CA
95831-3638
US

V. Phone/Fax

Practice location:
  • Phone: 916-921-0828
  • Fax:
Mailing address:
  • Phone: 916-706-4468
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number117842
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: