Healthcare Provider Details

I. General information

NPI: 1730159385
Provider Name (Legal Business Name): JONATHAN H MCKINNON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/25/2006
Last Update Date: 09/06/2023
Certification Date: 09/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7575 W WASHINGTON AVE SUITE 127-160
LAS VEGAS NV
89128-4333
US

IV. Provider business mailing address

351 N BUFFALO DR SUITE B
LAS VEGAS NV
89145-0301
US

V. Phone/Fax

Practice location:
  • Phone: 702-505-4230
  • Fax: 702-505-4231
Mailing address:
  • Phone: 702-505-4230
  • Fax: 702-505-4231

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084N0008X
TaxonomyNeuromuscular Medicine (Psychiatry & Neurology) Physician
License Number14137
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number36035
License Number StateAZ
# 3
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number14137
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: