MEDICARE: KAYLA MCKINNEY MS, CCC-SLP

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	235Z00000X	Speech-Language Pathologist	4183	AR

General Provider Information

NPI Number	:	1528748662
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAYLA MCKINNEY MS, CCC-SLP

Provider Business Mailing Address
First Line	:	12301 MARYLAND PL
Second Line	:
City	:	SHERWOOD
State	:	AR
Zip	:	72120-3093
Country	:	US
Telephone Number	:	501-951-3159
Fax Number	:

Provider Business Practice Location Address
First Line	:	17 PARKSTONE CIR
Second Line	:
City	:	NORTH LITTLE ROCK
State	:	AR
Zip	:	72116-7059
Country	:	US
Telephone Number	:	501-801-9705
Fax Number	:

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

Provider Enumeration Date	:	07/24/2023
Last Update Date	:	07/24/2023

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