Provider Demographics
NPI:1386248177
Name:MCKINNEY, BROOKLIN PAIGE
Entity type:Individual
Prefix:
First Name:BROOKLIN
Middle Name:PAIGE
Last Name:MCKINNEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:719 GUY MULLINS RD
Mailing Address - Street 2:
Mailing Address - City:MAYSEL
Mailing Address - State:WV
Mailing Address - Zip Code:25133-8124
Mailing Address - Country:US
Mailing Address - Phone:304-644-8998
Mailing Address - Fax:
Practice Address - Street 1:15 BANK ST
Practice Address - Street 2:
Practice Address - City:CLAY
Practice Address - State:WV
Practice Address - Zip Code:25043
Practice Address - Country:US
Practice Address - Phone:304-587-9992
Practice Address - Fax:304-587-9993
Is Sole Proprietor?:No
Enumeration Date:2020-11-23
Last Update Date:2020-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant