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General NPI Number Information
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NPI Number | 1609255611
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Entity Type | Individual
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Provider Name | ROY MCKINNIS
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Gender | Male
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Dates
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Enumeration Date | 05/22/2015
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Last Update Date | 05/22/2015
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Provider Practice Location Address
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Address Line | 5229 HALIFAX RD
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City | HALIFAX
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State | VA
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Zip | 24558-3179
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Country | US
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Telephone | 434-548-8752
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Fax |
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Provider Business Mailing Address
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Address Line | 124 GRANITE DR
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City | DANVILLE
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State | VA
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Zip | 24540-2883
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Country | US
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Telephone | 434-548-8752
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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 | 376K00000X
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Taxonomy Name | Nurse's Aide
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License Number | HCO-151054
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License Number State | VA
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