Healthcare Provider Details

I. General information

NPI: 1851381255
Provider Name (Legal Business Name): VALERIE SUE MCKINNIS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: VALERIE SUE BAUMAN

II. Dates (important events)

Enumeration Date: 10/26/2005
Last Update Date: 08/19/2022
Certification Date: 08/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1010 THREE SPRINGS BLVD
DURANGO CO
81301-8296
US

IV. Provider business mailing address

1010 THREE SPRINGS BLVD
DURANGO CO
81301-8296
US

V. Phone/Fax

Practice location:
  • Phone: 970-764-3352
  • Fax: 970-764-3375
Mailing address:
  • Phone: 970-764-3352
  • Fax: 970-764-3375

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number40492
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberDR.0040492
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: