Provider Demographics
NPI:1386335750
Name:MCKINNIS, EVELYN
Entity type:Individual
Prefix:
First Name:EVELYN
Middle Name:
Last Name:MCKINNIS
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 1:2276 FRANKLIN TPKE STE 106
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24540-5284
Mailing Address - Country:US
Mailing Address - Phone:434-489-9913
Mailing Address - Fax:434-836-8713
Practice Address - Street 1:2276 FRANKLIN TPKE STE 106
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:VA
Practice Address - Zip Code:24540-5284
Practice Address - Country:US
Practice Address - Phone:434-489-9913
Practice Address - Fax:434-836-8713
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-17
Last Update Date:2023-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care