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General NPI Number Information
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NPI Number | 1992963862
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Entity Type | Individual
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Provider Name | ELYSSA MARIE MCKINNEY DO
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Gender | Female
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Dates
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Enumeration Date | 05/28/2008
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Last Update Date | 01/29/2016
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Provider Practice Location Address
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Address Line | 640 WRIGHT AVE
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City | BOWLING GREEN
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State | KY
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Zip | 42103-1623
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Country | US
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Telephone | 859-605-6480
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Fax |
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Provider Business Mailing Address
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Address Line | 640 WRIGHT AVE
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City | BOWLING GREEN
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State | KY
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Zip | 42103-1623
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Country | US
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Telephone | 859-605-6480
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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 | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | 03223
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License Number State | KY
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 9543
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License Number State | KY
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