Healthcare Provider Details

I. General information

NPI: 1912436643
Provider Name (Legal Business Name): HELEN K MCKINNEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2017
Last Update Date: 06/08/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2001 CARLISLE BLVD NE
ALBUQUERQUE NM
87110-4939
US

IV. Provider business mailing address

6000 CORTADERIA ST NE APT 2614
ALBUQUERQUE NM
87111-8002
US

V. Phone/Fax

Practice location:
  • Phone: 505-503-7946
  • Fax:
Mailing address:
  • Phone: 540-632-6037
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberM-09958
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: