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General NPI Number Information
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NPI Number | 1457739823
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Entity Type | Individual
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Provider Name | MR. DALLEN MCKINNIS
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Gender | Male
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Dates
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Enumeration Date | 05/18/2015
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Last Update Date | 05/18/2015
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Provider Practice Location Address
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Address Line | 2276 FRANKLIN TPKE STE 106
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City | DANVILLE
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State | VA
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Zip | 24540-5284
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Country | US
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Telephone | 434-548-8752
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Fax | 434-836-8713
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Provider Business Mailing Address
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Address Line | 2276 FRANKLIN TPKE STE 106
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City | DANVILLE
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State | VA
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Zip | 24540-5284
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Country | US
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Telephone | 434-548-8752
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Fax | 434-836-8713
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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 | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number | HCO-15408
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License Number State | VA
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