Healthcare Provider Details

I. General information

NPI: 1669182085
Provider Name (Legal Business Name): MCKINLEY ROUNDING PROVIDERS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/28/2022
Last Update Date: 02/08/2023
Certification Date: 01/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4954 E 56TH ST
INDIANAPOLIS IN
46220-5773
US

IV. Provider business mailing address

3140 ARUNDEL LN
INDIANAPOLIS IN
46222-1815
US

V. Phone/Fax

Practice location:
  • Phone: 800-561-2078
  • Fax: 317-388-5655
Mailing address:
  • Phone: 317-439-9207
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: SHAHLINI KAYE MCKINLEY
Title or Position: NURSE PRACTITIONER
Credential: NP
Phone: 317-439-9207