Healthcare Provider Details

I. General information

NPI: 1962317040
Provider Name (Legal Business Name): MICHELLE LOUISE MCKINNEY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/14/2026
Last Update Date: 08/14/2026
Certification Date: 08/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

275 YOSEMITE PL
WOODLAND CA
95695-5841
US

IV. Provider business mailing address

275 YOSEMITE PL
WOODLAND CA
95695-5841
US

V. Phone/Fax

Practice location:
  • Phone: 530-554-6568
  • Fax:
Mailing address:
  • Phone: 530-554-6568
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License NumberFBB661FB60
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: