Healthcare Provider Details

I. General information

NPI: 1558831461
Provider Name (Legal Business Name): RHONDA JEAN MCKINNEY NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/04/2018
Last Update Date: 11/14/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2811 WASHINGTON AVE
BEDFORD IN
47421-5310
US

IV. Provider business mailing address

2811 WASHINGTON AVE
BEDFORD IN
47421-5310
US

V. Phone/Fax

Practice location:
  • Phone: 812-675-0902
  • Fax: 812-675-8251
Mailing address:
  • Phone: 812-675-0902
  • Fax: 812-675-8251

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number71008552A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: