Provider Demographics
NPI:1154009322
Name:MCKINNEY, RAYMOND CHARLES
Entity type:Individual
Prefix:
First Name:RAYMOND
Middle Name:CHARLES
Last Name:MCKINNEY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:387 OAK CREEK DR
Mailing Address - Street 2:
Mailing Address - City:LAVON
Mailing Address - State:TX
Mailing Address - Zip Code:75166-1932
Mailing Address - Country:US
Mailing Address - Phone:216-355-2500
Mailing Address - Fax:
Practice Address - Street 1:387 OAK CREEK DR
Practice Address - Street 2:
Practice Address - City:LAVON
Practice Address - State:TX
Practice Address - Zip Code:75166-1932
Practice Address - Country:US
Practice Address - Phone:216-355-2500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-07
Last Update Date:2023-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX45734352172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver