Healthcare Provider Details

I. General information

NPI: 1417953365
Provider Name (Legal Business Name): JEFFERY W. MCKINLEY D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2005
Last Update Date: 08/24/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

810 W COLUMBIA ST
OBERLIN KS
67749
US

IV. Provider business mailing address

810 W COLUMBIA ST
OBERLIN KS
67749-2450
US

V. Phone/Fax

Practice location:
  • Phone: 785-475-2208
  • Fax: 785-475-2453
Mailing address:
  • Phone: 785-475-2208
  • Fax: 785-475-2453

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0527824
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: