MEDICARE: KEYANA MARIE 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	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1528915055
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KEYANA MARIE MCKINNEY

Provider Business Mailing Address
First Line	:	10812 BLACKWATER CT
Second Line	:
City	:	MONTGOMERY
State	:	AL
Zip	:	36117-1223
Country	:	US
Telephone Number	:	334-451-1500
Fax Number	:

Provider Business Practice Location Address
First Line	:	10812 BLACKWATER CT
Second Line	:
City	:	MONTGOMERY
State	:	AL
Zip	:	36117
Country	:	US
Telephone Number	:	334-451-1500
Fax Number	:

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

Provider Enumeration Date	:	03/13/2026
Last Update Date	:	03/13/2026

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