Healthcare Provider Details

I. General information

NPI: 1205350683
Provider Name (Legal Business Name): ERIN KATHLEEN MCKINNEY FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2017
Last Update Date: 05/07/2024
Certification Date: 05/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11835 HAZEL CIRCLE DR
BRISTOW VA
20136-1223
US

IV. Provider business mailing address

11835 HAZEL CIRCLE DR
BRISTOW VA
20136-1223
US

V. Phone/Fax

Practice location:
  • Phone: 703-659-0855
  • Fax:
Mailing address:
  • Phone: 703-659-0855
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0024175197
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number0024175197
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: