Provider Demographics
NPI:1386811198
Name:MCKENNA, JAY (MD)
Entity type:Individual
Prefix:
First Name:JAY
Middle Name:
Last Name:MCKENNA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 W CENTRAL TEXAS EXPY STE 115
Mailing Address - Street 2:
Mailing Address - City:HARKER HEIGHTS
Mailing Address - State:TX
Mailing Address - Zip Code:76548-1888
Mailing Address - Country:US
Mailing Address - Phone:254-833-8456
Mailing Address - Fax:
Practice Address - Street 1:300 W CENTRAL TEXAS EXPY STE 115
Practice Address - Street 2:
Practice Address - City:HARKER HEIGHTS
Practice Address - State:TX
Practice Address - Zip Code:76548-1888
Practice Address - Country:US
Practice Address - Phone:254-833-8456
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-12
Last Update Date:2023-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME146695207Q00000X
HIMD-21320207Q00000X
GA059288207Q00000X
NC141451207Q00000X
TXM8179207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine