Healthcare Provider Details

I. General information

NPI: 1154305944
Provider Name (Legal Business Name): ANN STEWART MCKENNEY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 12/05/2005
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 CARPENTER RD
FT MYER VA
22211-1009
US

IV. Provider business mailing address

1814 N ODE ST
ARLINGTON VA
22209-1410
US

V. Phone/Fax

Practice location:
  • Phone: 703-696-3630
  • Fax:
Mailing address:
  • Phone: 703-516-0177
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number21429
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number21429
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: