MEDICARE: SHELIA YVONNE MCKINNEY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171W00000X	Contractor		TX
2	253J00000X	Foster Care Agency		TX

General Provider Information

NPI Number	:	1063839165
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHELIA YVONNE MCKINNEY

Provider Business Mailing Address
First Line	:	PO BOX 24446
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76124-1446
Country	:	US
Telephone Number	:	817-988-7602
Fax Number	:	817-413-5572

Provider Business Practice Location Address
First Line	:	4623 MILLER AVE STE B
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76119-5064
Country	:	US
Telephone Number	:	817-988-7602
Fax Number	:	817-413-5572

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/26/2014
Last Update Date	:	03/26/2014

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Directions to “ SHELIA YVONNE MCKINNEY ” Practice Location

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