MEDICARE: FELICIA DIANE 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	3747A0650X	Attendant Care Provider

General Provider Information

NPI Number	:	1821673153
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	FELICIA DIANE MCKINNEY

Provider Business Mailing Address
First Line	:	4504 WESTWOOD PARK DR
Second Line	:
City	:	SHREVEPORT
State	:	LA
Zip	:	71109-6223
Country	:	US
Telephone Number	:	318-799-4029
Fax Number	:

Provider Business Practice Location Address
First Line	:	4504 WESTWOOD PARK DR
Second Line	:
City	:	SHREVEPORT
State	:	LA
Zip	:	71109-6223
Country	:	US
Telephone Number	:	318-799-4029
Fax Number	:

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

Provider Enumeration Date	:	03/17/2021
Last Update Date	:	03/17/2021

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Directions to “ FELICIA DIANE MCKINNEY ” Practice Location

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