Healthcare Provider Details

I. General information

NPI: 1245790583
Provider Name (Legal Business Name): ABIGAL E MCKINNEY HIS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2019
Last Update Date: 03/22/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7413 US 42 STE 2
FLORENCE KY
41042-1999
US

IV. Provider business mailing address

600 6TH AVE
HUNTINGTON WV
25701-2104
US

V. Phone/Fax

Practice location:
  • Phone: 859-283-5404
  • Fax: 513-332-9072
Mailing address:
  • Phone: 304-521-4365
  • Fax: 513-332-9072

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number242072
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: