Healthcare Provider Details

I. General information

NPI: 1396372074
Provider Name (Legal Business Name): LILIAN PATRICE MCKINLEY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2020
Last Update Date: 06/30/2023
Certification Date: 06/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 E PARK AVE
STATE COLLEGE PA
16803-6701
US

IV. Provider business mailing address

1800 E PARK AVE
STATE COLLEGE PA
16803-6797
US

V. Phone/Fax

Practice location:
  • Phone: 814-278-4818
  • Fax: 814-234-6150
Mailing address:
  • Phone: 814-278-4818
  • Fax: 814-234-6150

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberML61058352
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD480971
License Number StatePA

VII. Legacy identifiers

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: