Healthcare Provider Details

I. General information

NPI: 1336402312
Provider Name (Legal Business Name): AMY ELIZABETH MCKINNELL LM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/24/2012
Last Update Date: 02/27/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5854 KUMQUAT RD APT A
WEST PALM BEACH FL
33413-1800
US

IV. Provider business mailing address

5854 KUMQUAT RD APT A
WEST PALM BEACH FL
33413-1800
US

V. Phone/Fax

Practice location:
  • Phone: 561-287-0102
  • Fax:
Mailing address:
  • Phone: 561-287-0102
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License Number303
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: