MEDICARE: ALYX 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	103K00000X	Behavior Analyst	0-17-8093	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1477009694
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALYX MCKINNEY

Provider Business Mailing Address
First Line	:	13201 SUGARBLUFF RD
Second Line	:
City	:	CLERMONT
State	:	FL
Zip	:	34715-6819
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	365 CITRUS TOWER BLVD STE 116
Second Line	:
City	:	CLERMONT
State	:	FL
Zip	:	34711-6532
Country	:	US
Telephone Number	:	352-223-1999
Fax Number	:

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

Provider Enumeration Date	:	08/28/2016
Last Update Date	:	01/24/2019

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Directions to “ ALYX MCKINNEY ” Practice Location

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