Provider Demographics
NPI:1063184364
Name:MCKINLEY, ANDREA (CCE (BFW))
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:
Last Name:MCKINLEY
Suffix:
Gender:F
Credentials:CCE (BFW)
Other - Prefix:
Other - First Name:ANDREA
Other - Middle Name:
Other - Last Name:DENALI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CCE (BFW)
Mailing Address - Street 1:622 MCADAMS RD
Mailing Address - Street 2:
Mailing Address - City:HILLSBOROUGH
Mailing Address - State:NC
Mailing Address - Zip Code:27278-2113
Mailing Address - Country:US
Mailing Address - Phone:919-370-1940
Mailing Address - Fax:
Practice Address - Street 1:930 MARTIN LUTHER KING JR BLVD STE 300
Practice Address - Street 2:
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27514-2656
Practice Address - Country:US
Practice Address - Phone:919-370-1940
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-04
Last Update Date:2021-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
172V00000X, 374J00000X, 174H00000X
NC18346173C00000X, 225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174H00000XOther Service ProvidersHealth EducatorGroup - Multi-Specialty
No172V00000XOther Service ProvidersCommunity Health Worker
No173C00000XOther Service ProvidersReflexologist
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No374J00000XNursing Service Related ProvidersDoulaGroup - Multi-Specialty