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General NPI Number Information
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NPI Number | 1932379658
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Entity Type | Organization
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Legal Business Name | MELISSA A. MCKINNEY, D.O., P.L.L.C.
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Dates
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Enumeration Date | 03/10/2008
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Last Update Date | 03/14/2008
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Provider Practice Location Address
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Address Line | 4283 PIMA WAY
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City | LAKE MONTEZUMA
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State | AZ
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Zip | 86342-5087
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Country | US
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Telephone | 928-592-9140
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Fax | 928-592-9144
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Provider Business Mailing Address
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Address Line | 2370 W HWY 89A #11 PMB 412
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City | SEDONA
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State | AZ
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Zip | 86336-5341
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Country | US
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Telephone | 928-592-9140
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Fax | 928-592-9144
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Authorized Official
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Title or Position | PHYSICIAN
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Name | MELISSA A. MCKINNEY
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Credential | D.O.
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Telephone | 928-592-9140
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | 4057
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License Number State | AZ
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