Healthcare Provider Details

I. General information

NPI: 1063170215
Provider Name (Legal Business Name): LESLIE MORGAN MCKINNEY APRN, CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/06/2021
Last Update Date: 09/04/2026
Certification Date: 09/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

108 WASHINGTON ST W STE 201
CHARLESTON WV
25302-2344
US

IV. Provider business mailing address

97 GREAT TEAYS BLVD STE 6
SCOTT DEPOT WV
25560-9816
US

V. Phone/Fax

Practice location:
  • Phone: 304-345-2229
  • Fax:
Mailing address:
  • Phone: 304-757-6999
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number112089
License Number StateWV
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number75095
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: