Healthcare Provider Details

I. General information

NPI: 1801015839
Provider Name (Legal Business Name): PHYLLIS MCKINNEY NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/25/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3009 BROADWAY BARNARD HEALTH SERVICE
NEW YORK NY
10027-6905
US

IV. Provider business mailing address

588 HENRY ST
BROOKLYN NY
11231-2727
US

V. Phone/Fax

Practice location:
  • Phone: 212-854-2091
  • Fax: 212-854-2702
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberF3301551
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: