Provider Demographics
NPI:1093791493
Name:MCKINNEY, JIM EDWARD (PA)
Entity type:Individual
Prefix:MR
First Name:JIM
Middle Name:EDWARD
Last Name:MCKINNEY
Suffix:
Gender:
Credentials:PA
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:6600 S YALE AVE STE 1400
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74136-3331
Mailing Address - Country:US
Mailing Address - Phone:918-499-4855
Mailing Address - Fax:
Practice Address - Street 1:102 S MAIN ST
Practice Address - Street 2:
Practice Address - City:SAND SPRINGS
Practice Address - State:OK
Practice Address - Zip Code:74063-6509
Practice Address - Country:US
Practice Address - Phone:918-245-2286
Practice Address - Fax:918-241-4366
Is Sole Proprietor?:No
Enumeration Date:2005-12-16
Last Update Date:2025-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK970363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
P03390Medicare UPIN