Provider Demographics
NPI:1114727443
Name:MCKINNEY, MICHELLE LEANNE
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:LEANNE
Last Name:MCKINNEY
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 1:315 JACOB LN
Mailing Address - Street 2:
Mailing Address - City:LONDON
Mailing Address - State:OH
Mailing Address - Zip Code:43140-9366
Mailing Address - Country:US
Mailing Address - Phone:937-681-6546
Mailing Address - Fax:
Practice Address - Street 1:315 JACOB LN
Practice Address - Street 2:
Practice Address - City:LONDON
Practice Address - State:OH
Practice Address - Zip Code:43140-9366
Practice Address - Country:US
Practice Address - Phone:937-681-6546
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-17
Last Update Date:2025-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN.501955363LS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LS0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerSchool