MEDICARE: DR. JUANKEE JEVONNE MCKINNEY PH.D.

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	174400000X	Specialist	01734	MO

General Provider Information

NPI Number	:	1679786032
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JUANKEE JEVONNE MCKINNEY PH.D.

Provider Business Mailing Address
First Line	:	5714 BARTMER AVE
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63112-2811
Country	:	US
Telephone Number	:	314-454-1267
Fax Number	:	314-454-1267

Provider Business Practice Location Address
First Line	:	4144 LINDELL BLVD
Second Line	:	SUITE 501
City	:	SAINT LOUIS
State	:	MO
Zip	:	63108-2927
Country	:	US
Telephone Number	:	314-531-4743
Fax Number	:

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

Provider Enumeration Date	:	05/08/2007
Last Update Date	:	10/27/2022

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