Provider Demographics
NPI:1215917208
Name:MCGINNIS, SALLY J (FNP-C)
Entity type:Individual
Prefix:
First Name:SALLY
Middle Name:J
Last Name:MCGINNIS
Suffix:
Gender:
Credentials:FNP-C
Other - Prefix:
Other - First Name:SALLY
Other - Middle Name:J
Other - Last Name:SOFFA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNP
Mailing Address - Street 1:4055 VALLEY VIEW LN STE 700
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75244-5045
Mailing Address - Country:US
Mailing Address - Phone:877-868-5351
Mailing Address - Fax:
Practice Address - Street 1:800 S GAY ST STE 700
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37929-9703
Practice Address - Country:US
Practice Address - Phone:877-868-5351
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-18
Last Update Date:2025-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.18219363LF0000X
TN37678363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0151797Medicaid
OH0151797Medicaid