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General NPI Number Information
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NPI Number | 1104019470
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Entity Type | Individual
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Provider Name | CARLYN ILENE MCKINNEY PT CWS
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Gender | Female
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Dates
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Enumeration Date | 08/21/2007
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Last Update Date | 08/21/2007
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Provider Practice Location Address
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Address Line | 6818A HIGHWAY 84
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City | FERRIDAY
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State | LA
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Zip | 71334-5101
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Country | US
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Telephone | 318-757-7575
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Fax |
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Provider Business Mailing Address
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Address Line | 111 CHERRYBARK LN
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City | NATCHEZ
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State | MS
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Zip | 39120-9377
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Country | US
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Telephone | 601-442-9494
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 282E00000X
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Taxonomy Name | Long Term Care Hospital
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License Number | 03702
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License Number State | LA
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