Provider Demographics
NPI:1114723152
Name:MCKINNON, KARISSA
Entity type:Individual
Prefix:
First Name:KARISSA
Middle Name:
Last Name:MCKINNON
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:238 BORDEAUX ST
Mailing Address - Street 2:
Mailing Address - City:CHADRON
Mailing Address - State:NE
Mailing Address - Zip Code:69337-2394
Mailing Address - Country:US
Mailing Address - Phone:308-430-2599
Mailing Address - Fax:
Practice Address - Street 1:238 BORDEAUX ST
Practice Address - Street 2:
Practice Address - City:CHADRON
Practice Address - State:NE
Practice Address - Zip Code:69337-2394
Practice Address - Country:US
Practice Address - Phone:308-430-2599
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-20
Last Update Date:2025-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372500000XNursing Service Related ProvidersChore Provider
No372600000XNursing Service Related ProvidersAdult Companion