Healthcare Provider Details

I. General information

NPI: 1316981566
Provider Name (Legal Business Name): DANIEL C MCKINNEY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/16/2006
Last Update Date: 02/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 BUSINESS PARK DR SUITE A
BRANSON MO
65616-7426
US

IV. Provider business mailing address

115 BUSINESS PARK DR SUITE A
BRANSON MO
65616-7426
US

V. Phone/Fax

Practice location:
  • Phone: 417-339-7337
  • Fax: 417-339-7345
Mailing address:
  • Phone: 417-339-7337
  • Fax: 417-339-7345

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberR2C46
License Number StateMO

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier2400
Identifier TypeOTHER
Identifier State
Identifier IssuerCOX HEALTH SYSTEMS
# 2
Identifier201878667
Identifier TypeMEDICAID
Identifier StateMO
Identifier Issuer
# 3
Identifier223879
Identifier TypeOTHER
Identifier State
Identifier IssuerHEALTHLINK
# 4
Identifier12952
Identifier TypeOTHER
Identifier State
Identifier IssuerBCBS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: