=====================================================
General NPI Number Information
=====================================================
NPI Number | 1487837183
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LORRAINE E MCKINNEY DPM PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/17/2007
-----------------------------------------------------
Last Update Date | 05/10/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5751 BLYTHEWOOD ST STE 200
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77021-5404
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 281-402-3561
-----------------------------------------------------
Fax | 281-936-0303
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 38228
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77238-8228
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 281-402-3561
-----------------------------------------------------
Fax | 281-936-0303
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PODIATRIST
-----------------------------------------------------
Name | DR. LORRAINE ELIZABETH MCKINNEY
-----------------------------------------------------
Credential | DPM
-----------------------------------------------------
Telephone | 281-402-3561
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 213E00000X
-----------------------------------------------------
Taxonomy Name | Podiatrist
-----------------------------------------------------
License Number | 1799
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------