Provider Demographics
NPI:1306948914
Name:MCKINNEY, KARYN ELAINE (DMD)
Entity type:Individual
Prefix:DR
First Name:KARYN
Middle Name:ELAINE
Last Name:MCKINNEY
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:359 MEDICAL GROUP
Mailing Address - Street 2:221 THIRD STREET WEST
Mailing Address - City:JBSA-RANDOLPH
Mailing Address - State:TX
Mailing Address - Zip Code:78150
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2931 HARNEY PATH
Practice Address - Street 2:
Practice Address - City:FORT SAM HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:78234-7674
Practice Address - Country:US
Practice Address - Phone:210-808-1109
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-03
Last Update Date:2018-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA19989122300000X
PADS030864L122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA030864OtherUS AIR FORCE