Healthcare Provider Details

I. General information

NPI: 1174962161
Provider Name (Legal Business Name): CARRIE LEE MCKINNEY FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2013
Last Update Date: 07/02/2026
Certification Date: 07/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

137 SAYERS ST
NORTH TAZEWELL VA
24630-9203
US

IV. Provider business mailing address

137 SAYERS ST
NORTH TAZEWELL VA
24630-9203
US

V. Phone/Fax

Practice location:
  • Phone: 434-665-5066
  • Fax: 434-423-4461
Mailing address:
  • Phone: 434-665-5066
  • Fax: 434-423-4461

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0024170940
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: