Healthcare Provider Details

I. General information

NPI: 1598258683
Provider Name (Legal Business Name): MICHELLE KAY MCKENNA DNP, ARNP, CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2018
Last Update Date: 08/15/2025
Certification Date: 08/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 W TERRELL AVE STE 320
FORT WORTH TX
76104-2822
US

IV. Provider business mailing address

2080 CHILD ST DEPT 5000
JACKSONVILLE FL
32214-5000
US

V. Phone/Fax

Practice location:
  • Phone: 817-250-7360
  • Fax: 817-250-0125
Mailing address:
  • Phone: 904-542-7419
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License NumberAP60856999
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number1186586
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: