Provider Demographics
NPI:1285989152
Name:MCKINNEY, ANGELA G (NP-C)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:G
Last Name:MCKINNEY
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 507
Mailing Address - Street 2:RR 103 SUPPLY STREET
Mailing Address - City:GARY
Mailing Address - State:WV
Mailing Address - Zip Code:24836-0507
Mailing Address - Country:US
Mailing Address - Phone:304-448-2101
Mailing Address - Fax:304-448-3217
Practice Address - Street 1:904 HARRISON ST
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:WV
Practice Address - Zip Code:24740-3011
Practice Address - Country:US
Practice Address - Phone:304-431-7100
Practice Address - Fax:304-431-7112
Is Sole Proprietor?:No
Enumeration Date:2012-07-17
Last Update Date:2025-01-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WV51212363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810023868Medicaid
WVWV1829AMedicare PIN
WVWV1829BMedicare PIN
WV3810023868Medicaid